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  • Küçük Resim
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    Risky anatomic variations of sphenoid sinus for surgery
    (Springer, 2006) Ünal, Birsen; Bademci, Gülşah; Bilgili, Yasemin K.; Batay, Funda; Avcı, Emel
    We searched for the surgically risky anatomic variations of sphenoid sinus and aimed to compare axial and coronal tomography in detection of these variations. Fifty-six paranasal tomography images (112 sides) were evaluated for coronal, axial and both coronal and axial images. Tomographic findings including bony septum extending to optic canal or internal carotid artery; protrusions and dehiscences of the walls of internal carotid artery, optic nerve, maxillary nerve and vidian nerve; extreme medial course of internal carotid artery; patterns of aeration of the anterior clinoid process; and Onodi cells were evaluated. The results were classified as "present, absent, suspicious-thin (only for dehiscence) or no-consensus". The results of each plane were compared with that of the result of the both planes together. Kappa coefficient and Chi-square tests were used to compare both planes. Twelve cadaveric dissections were performed to reveal the proximity of sphenoid sinus to surgically risky anatomic structures. Endoscopy was applied to five cadavers. 18 evaluations were classified as 'no-consensus'. We detected 34, 35, 34 and 40 protrusions of internal carotid artery, optic nerve, maxillary nerve, vidian nerve, respectively. Dehiscences were present in 6, 9, 4 and 8, and suspicious-thin in 8, 10, 16 and 25 in canals of internal carotid artery, optic nerve, maxillary nerve and vidian nerve, respectively. Bony septum to internal carotid artery and optic nerve was observed in 30 and 22 cases. We observed 9 extreme medial courses of internal carotid artery, 27 aerated clinoid process and 9 Onodi cells. Axial images were superior in detection of bony septum to internal carotid artery and Onodi cells; while the coronal images were more successful in detection of protrusion of optic nerve and vidian nerve, and dehiscense of maxillary nerve and vidian nerve (P < 0.05). In cadaveric dissections, the septa were inserted into the bony covering of the carotid arteries in two sinuses (8.3%). Detailed preoperative analysis of the anatomy of the sphenoid sinus and its boundaries is crucial in facilitating entry to the pituitary fossa and reducing intraoperative complications. Coronal tomography more successfully detects the sphenoid sinus anatomic variations.
  • Küçük Resim
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    Sildenafil does not alter retrobulbar hemodynamics in postural variations
    (Taylor & Francis Inc, 2005) Taner, Pelin; Ergin, Ahmet; Basar, M. Murad; Batislam, Ertan; Bilgili, Yasemin K.
    Objectives: In the present study, we aimed to investigate the postural changes of systemic blood pressure, retrobulbar blood flow velocities, and intraocular pressure as a response to sildenafil. Material and methods: A total of 28 healthy volunteers with an average age of 51.4 +/- 0.5 years ( range: 46 - 53 years) were divided into two groups: study group ( Group 1) and control group ( Group 2). After baseline measurements of retrobulbar blood velocity in the ophthalmic, central retinal, and posterior ciliary arteries using color Doppler imaging and intraocular pressure were noted in both groups, sildenafil citrate ( 50 mg) was given to the participants in Group 1. All parameters were then remeasured in the sitting and supine positions. Mann-Whitney U test, Friedman variant analysis, and Wilcoxon two-related sample test were used to evaluate changes of these parameters with regard to position in both groups. Results: Changing from a sitting to a supine position decreased the systolic and diastolic blood pressures in both groups. These changes were not statistically significant between groups ( p > 0.05). Intraocular pressure showed statistically insignificant increases in the supine position in both groups ( p > 0.05). There were no statistically significant differences between the two groups with regard to the retrobulbar hemodynamic parameters in two ( sitting and supine) positions ( p > 0.05). Conclusion: This is the first clinical study on the effects of sildenafil on retrobulbar and systemic hemodynamics in postural variations. Retrobulbar hemodynamics, intraocular pressure, and systemic blood pressure are the same in patients who use recommended doses of sildenafil as in physiological conditions.