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Öğe Acil Ünitesine Kafa Travması Nedeni İle Başvuran Olguların Değerlendirme Sonuçları(2016) Akgül, Mehmet; Burulday, VeyselGiriş: Kalıcı hasara ve ölüme neden olan beyin ve omurilik yaralanmaları gelişmiş toplumlarda önemli bir sağlık sorunu oluşturmaya devam etmektedir. Kazalar yaralanmaların en önemli nedenini oluşturmaktadır. Çalışmamızın amacı kafa travmalarının sıklığını, nedenlerini ve sonuçlarını incelemek, oluşan patolojik bulguların önemini vurgulamaktır. Gereç ve Yöntem: 2 Kırıkkale Üniversitesi Tıp Fakültesi acil bölümüne 2015- 2016 tarihleri arasında kafa travması nedeni ile Beyin cerrahisi bölümünce değerlendirilen ardışık 100 olgunun tanımlayıcı analizleri gerçekleştirildi. Bu hastaların 69'u erkek, 31'i bayandı. Hastaların çekilen Kranial Bilgisayarlı Tomografileri "Marshall skoru" ile analiz edildi. Hastaların yaş, cins, kafa travma nedenleri, geliş Glaskow Koma Skoru (GKS) ve Glaskow Outcome Skorları (GOS) kayıt edildi. Bulgular: Hastaların Marshall skoru %94 ünde Grade I idi. Dört olguda Grade II, 1 olguda Grade III, 2 olguda ise Grade IV idi. Geliş GKS %92'sinde 15, altı olguda 14, iki olguda 3 idi. GOS'ları ise 96 olguda 5, bir olguda 3, üç olguda 1 idi. Olguların yaş ortalaması 34.222.2 (Yaş aralığı: 1-83 yıl) idi. Olguların cinsiyet grubuna göre kaza nedenlerine bakıldığında erkeklerde araç dışı trafik kazası (ADTK), (%13'e karşılık %6.5), darp (%11.6'ya karşılık %3.2) bayanlara göre daha fazla gözlenmekteydi. Buna karşılık kadınlarda ise, araç içi trafik kazası (AİTK) (%45.2'ye karşılık %23.2) erkeklerden daha fazla gözlemlenmiştir. Kadınlarda düşme sonucunda yaralanma erkeklerden biraz daha yüksekti. Sonuçlara bakıldığında 16-30 yaş dışındaki tüm gruplarda kafa travmasının en sık nedeni düşme olarak saptandı. 16-30 yaş grubunda ise kafa travmasından en fazla AİTK sorumluydu. Sonuç: Her yaş grubunda en sık travma nedeni olarak düşmenin saptanmasının etiyolojisinde bölgenin kırsal özellikleri nedeniyle tarımla geçinen bir bölge olduğu düşünülmüştür. Yaşam koşullarının iyileştirilmesi ve ekonomik düzeyin yükseltilmesi ile yapılacak ergonomik çalışmalar bu sonucun çözümüne katkıda bulunacaktır.Öğe Anatomical Considerations: The Relationship Between The Vertebral Artery And Transverse Foramina At Cervical Vertebrae 1 To 6 In Patients With Vertigo(2018) Kültür, Turgut; Muluk, Nuray Bayar; Iyem, Cihan; Inal, Mikail; Burulday, Veysel; Alpua, Murat; Çelebi, Umut OrkunObjective: In this study, we aimed to investigate the relationship between the size of the vertebral artery and that of the transverse foramina at the C1 to C6 vertebral level in patients suffering from vertigo thought to be related to vertebrobasilar insufficiency (VBI). Materials and Methods: In this retrospective study, two groups were compared in terms of cervical computed tomography (CT): 22 adult patients with vertigo; and a control group consisting of 23 healthy adult indivıduals. Measurement of the vertebral artery and transverse foramina (i.e. sagittal and transverse dimensions, plus area) were performed bilaterally at levels C (cervical vertebra) 1 to C6. Results: For the cases group, at C6 level the right vertebral artery area, sagittal and transverse diameter were larger than in the control group at the level of statistical significance. At C1 level, the area of the right transverse foramina in the cases group was significantly higher than in the control group. At levels C1 to C5, the values obtained for vertebral artery area were positively correlated with the values for the ipsilateral transverse foramina (transverse foramen sagittal and transverse dimensions plus areas). Where the sagittal or transverse dimensions of the transverse foramina, or the area of the transverse foramina were found to be decreased, vertebral artery areas were also observed to have decreased at C1 to C5 levels. Conclusion: We concluded that a decrease in diameter of the bony structures or transverse foramina may cause a decrease in the cross-sectional area of the vertebral artery on the ipsilateral side. Since it is only the left vertebral artery which is dominant for cerebral blood flow, any compensatory increase in right vertebral artery area cannot offset decreased cerebral blood flow. Decreased blood flow (i.e. VBI) on the left side may play a role in the development of vertigo.Öğe Can Achilles tendon be used as a new distal landmark for coronal tibial component alignment in total knee replacement surgery? An observational MRI study(Dove Medical Press Ltd, 2017) Tiftikci, Ugur; Serbest, Sancar; Burulday, VeyselBackground: In total knee arthroplasty, it is better to use more than one reference point for correct alignment of the components. By measuring the distances of Achilles tendon (AT) and other conventional landmarks from the mechanical axis in magnetic resonance imaging (MRI) of the ankle, we aimed to demonstrate that, as a novel landmark which can help for correct alignment in the coronal plane, AT is a better option than other landmarks. Materials and methods: This retrospective study was done on 53 ankle MRIs that met the criteria for inclusion to the study among 158 ankle MRIs. After identification of the mechanical axis, the distances of distal landmarks, which were extensor hallucis longus tendon (EHLT), tibialis anterior tendon (TAT), dorsalis pedis artery (DPA), AT, extensor digitorum longus tendon (EDLT), and malleoli, were measured from the mechanical axis and were statistically evaluated. Results: In proximal measurements, the distances of the landmarks to the mechanical axis (on average) were AT, 2.64 +/- 1.62 mm lateral; EHLT, 3.89 +/- 2.45 mm medial; DPA, 4.69 +/- 2.39 mm medial; TAT, 8.24 +/- 3.60 mm medial; and EDLT, 14.2 +/- 4.14 mm lateral (P<0.001). In distal measurements, the distances of the landmarks to the mechanical axis (on average) were AT, 1.99 +/- 1.24 mm medial; EHLT, 4.27 +/- 2.49 mm medial; DPA, 4.79 +/- 2.10 mm medial; TAT, 12.9 +/- 4.07 mm medial; and EDLT, 12.18 +/- 4.17 mm lateral (P<0.001). Conclusion: In this study, the mechanical axis line, which is the center of talus, passes through the AT. Our MRI investigations showed that the AT, EHLT, DPA, and malleolar center (3-5 mm medial) may help in correct alignment.Öğe Changes in the Anatomical Nomenclature of Sella Turcica: Turkish Saddle(Bentham Science Publ Ltd, 2018) Akgul, Mehmet Huseyin; Burulday, Veysel; Muluk, Nuray BayarBackground: 'Sella turcica' was first described in 1543. The "De humani corporis fabrica" is the name of a book by Andreas Vesalius that first described the 'sella turcica'. After this date, it was called the 'sella ephippi', 'sphenoidis sella', or 'sella equine'. In 1627, the famous anatomist Adrianus Spigelius developed the current definition of the term. Discussion: The Ottoman military power was at its highest level and a serious threat to Europe at the time so it was indicative of the sense of Turkish power to use 'sella turcica' as a medical term. Spigelius had investigated Turkish daily life, art, and culture in the sixteenth century, and Turks were common exemplars of an orientalist fashion that was being pioneered in Europe, which may be how this term came about. 'Sella' was used because of its similarity to the Turkish saddle; other such similarities included the amygdala and pear, hippocampus and almond, and priformis and seahorse. Conclusion: In this study, the anatomical, hormonal, and historical characteristics of 'sella turcica' are reviewed.Öğe Changes of normal appearing optic nerve head on diffusion-weighted imaging in patients with diabetic retinopathy(Elsevier Science Inc, 2017) Yilmaz, Sevda; Yumusak, Erhan; Burulday, VeyselPurpose: To investigate whether there is any change by measuring ADC values particularly of the optic nerve head (ONH) in patients with diabetic retinopathy (DR). Material and methods: ADC values at the ONHs was measured in 56 patients and 68 controls. Results: ADC values of ONHs were significantly higher in patients with DR compared to controls (p = 0.011). ADC values in patients with macular edema were higher than those without macular edema (p = 0.017). Conclusion: DWI of ONHs can be useful in cases where it is difficult to assess macular edema during fundus examination, especially in diabetic patients with cataract. (C) 2016 Elsevier Inc. All rights reserved.Öğe Comparison of diffusion-weighed MRI findings of the testis in patients with the advanced stage unilateral testicular varicocele(2017) Burulday, Veysel; Şahan, Mehmet Hamdi; Erdem, Gülnur; Yuvanç, ErcanThe aim of this study was to compare the testicular apparent diffusion coefficient (ADC) values of the patients with unilateral advanced stage varicocele and healthy volunteers. Twenty-seven patients with unilateral advanced stage varicocele and twenty-seven healthy volunteers were included in the study. Those with a diagnosis of clinical varicocele and the healthy volunteers were examined clinical and color Doppler ultrasonography. Patients with a unilateral (left) varicocele clinically grade III, color Doppler ultrasound grade IV-V were included in the study. All the patients and healthy volunteers were obtained ADC values. Mean values were calculated and statistical comparison was performed. ADC values were analysed by using an independent t test for each participant. Pearson's correlation test was used for the comparison of left pampiniform venous diameter and both testicular parenchymal ADC values. Left testicular ADC values were observed to be significantly lower when a comparison of the testicular parenchymal with left advanced stage varicocele and healthy volunteers revealed significantly low left testicular ADC values in patients (p0.05) Furthermore, a negative correlation was detected between the increase in the left testicular venous diameter and parenchymal ADC values of the bilateral testis in patients with left advanced stage varicocele (left p -624, right p -0.382). Diffusion weighted magnetic resonance imaging may be beneficial in defining the testicular damage in patients with varicoceleÖğe Cranial Magnetic Resonance Imaging Findings of Bonzai Abuse: A Case Report(2016) Burulday, Veysel; Koç, Ural; Tan, Sinan; İnal, Mikail; Alpua, MuratSentetik kannabinoidler (SK) Avrupa da Spice, ABD de K2, diğer taraftan Türkiye de Bonzai ismiyle popülerleş- mişlerdir. Çağımızın tehlikesi Bonzai, komplikasyonları ve nöroradyolojik bulguları literatürde çok bilinmeyen, son zamanlarda Türkiye de popüler olan bir bitkisel kaynaklı sentetik kannabinoid ilaçtır. Bunun sonucu olarak Bon- zai veya Bonzai ilişkili komplikasyonlar konusunda rad- yoloğun nöroradyolojik olarak farkında olması önemlidir. Biz bu olgu sunumunda, bilgisayarlı tomografide iskemi ile ilişkili olabilecek hipodens alanları olan, diğer taraf- tan magnetik rezonans görüntülemesinde T2 ağırlıklı ve FLAIR sekanslarda vazojenik ödemle uyumlu olduğu dü- şünülen Bonzai suistimali olgusunun kranial görüntüleme bulgularını sunduk. Ek olarak FLAIR görüntülemede kor- pus kallozumda sinyal artışı ve kanama odakları izlendi.Öğe Determination of S1 screw adjustment parameters using by 3D CT images in healthy subjects(2019) Akgül, Mehmet Hüseyin; Burulday, Veysel; Öğden, Mustafa; Yüksel, UlaşBackground: The aim of this study was to investigate the anthropometry of the posterior superior iliac spine (PSIS) types in the Turkish population and to determine the safe limits of the length and angle of the sacrum by the posterior lumber approach in lumbosacral instrumentation surgery.Material and Method: Sacral regions (left and right pedicle lengths and pedicle angles) and PSIS types of healthy subjects were evaluated using 3D images.Results: A total of 111 patients (58 males and 53 females) were included in the study. The mean age was 46.9 ± 14.8 in males and 44.3 ± 16.4 in females. In men, the right pedicle length was 52.83 mm, the left pedicle length was 53.81 mm, the right pedicle angle was 35.84, the left pedicle angle was 35.13, and the caudal angle was 39.24 degrees. In females, right pedicle length was 48.88 mm, left pedicle length was 49.28 mm, right and left pedicle angle was 35.83, and caudal angle was 39.24 degrees. PSIS type 1 was found to be 58.6%, type 2 32.4% and type 3 9%.Conclusion: Optimal screw lengths, angles and proper screw orientations can be easily and safely operated in posterior stabilization. In this study, morphometric and anthropometric information related to sacral screw orientation were also determined. These data may help to prevent surgical complications by contributing to the surgeon about preoperative anatomical structure in lumbosacral surgery stabilization procedures.Öğe Diffusion-weighted magnetic resonance imaging in diabetic retinopathy(2018) Burulday, Veysel; Örnek, Kemal; İnal, Mikail; Güler, Hatice Ayhan; Daphan, Birsen Ünal; Örnek, NurgülDiabetic retinopathy (DR) is a complication of diabetes mellitus (DM) that may causes blindness. The vitreous is an extracellular matrix and it may have changes through liquefaction and syneresis in patients with DM, even in those without apparent DR. Diffusion-weighted imaging (DWI) is a new technique provide tissue contrast relying on difference with the diffusion of water molecules among tissues, which can be measured by the apparent diffusion coefficient (ADC) value. We aimed to investigate the vitreous of patients in different stages of DR using diffusion-weighted imaging technique. This prospective study included a group of 100 patients with DR and 100 members of an age- and gender-matched control group. All groups were tested using a head coil in conduction with a Achieva 1.5T magnetic resonans imaging (MRI) system (Philips Medical Systems, Best, The Netherlands). The mean ADC values were calculated and used for statistical comparisons. Mean duration of diabetes was 12.22±10.13 years in patients. Compared to controls, both eyes of the DR group had statistically and significantly lower values of ADC (p=0.025 and p=0.002, respectively). No significant correlations were found among the ADC values and central macular thickness, disease duration and stage of DR (all p>0.05) in patients. Mean ADC values revealed no significant differences among the subgroups of patients at different stages of DR (all p>0.05). Decreased ADCs in the vitreous of diabetes patients seem to be associated with the presence of diabetic retinopathy.Öğe Evaluation Of Optic Nerve With Strain And Shear Wave Elastography In Patients With Behcet's Disease And Healthy Subjects(Elsevier Science Inc, 2017) Inal, Mikail; Tan, Sinan; Demirkan, Serkan; Burulday, Veysel; Gunduz, Ozgur; Ornek, KemalThe objective of this study was to investigate the elasticity characteristics of the optic nerve using strain and shear wave elastography in patients with Behc, et's disease and to compare the results with those of healthy volunteers. Forty-six optic nerves from patients with Behc, et's disease and 54 optic nerves from healthy volunteers were investigated prospectively in this study using strain and shear wave elastography. There was a statistically significant difference in terms of elasticity patterns between patients and healthy volunteers (p < 0.001). Elastographic images of healthy volunteers revealed most optic nerves to be type 3 (51.8%); however, type 2 (40.7%) and type 1 (7.5%) were also observed. Elastographic examination of Behc, et's disease patients revealed type 2 in 52.2%, type 1 in 43.5% and type 3 in 4.3% of patients. Statistically significant differences were observed between patients and healthy volunteers in the analysis of shear wave elastography values (p < 0.001). Receiver operating characteristic curve analysis was perfect (0.933) (95% CI = 0.885-0.980), and a cutoff value of 16.5 kPa shear had very high sensitivity and specificity for the patient group. Strain and shear wave elastography findings for the optic nerves of patients with Behc, et's disease were significantly different from those for healthy volunteers. (E-mail: inal_m@hotmail.com) (C) 2017 World Federation for Ultrasound in Medicine & Biology.Öğe Evaluation of posterior clinoid process pneumatization by multidetector computed tomography(Springer, 2017) Burulday, Veysel; Akgul, Mehmet Huseyin; Muluk, Nuray Bayar; Ozveren, Mehmet Faik; Kaya, AhmetIn the present study, we investigated the types and ratio of posterior clinoid process (PCP) pneumatization in paranasal sinus multidetector computed tomography (MDCT). Paranasal MDCT images of 541 subjects (227 males, 314 females), between 15 and 65 years old, were included into the study. Pneumatization of anterior clinoid process and pneumatization types (I, II, or III) were evaluated in the males and females. PCP pneumatization was detected in 20.7 % of the males and 11.5 % of the females. Right, left, and bilateral PCP pneumatizations were detected in 7.9, 5.7, and 7.0 % of the males and 2.9, 3.2, and 4.5 % of the females, respectively. PCP pneumatization of the males is significantly higher than the females. The most detected type of pneumatization was type I (61.2 %) for all groups. In right, left, and bilateral pneumatizations separately, type I pneumatization was the most detected pneumatization type with the ratio of the 70.4, 65.2, and 50.0 %, respectively. In males, type I (61.7 %), and similarly in females, type I (60.6 %) pneumatization were detected more. Type II and type III pneumatizations were detected in decreasing order in both groups. In younger subjects, pneumatization of posterior clinoid process was found as higher, and in older subjects, PCP pneumatization was found as lower. Sclerosis process related to the aging may be responsible for the lower pneumatization ratios in older subjects. Structure of the surrounding regions of PCP is important for surgical procedures related to cavernous sinus, basilar apex aneurysms, and mass lesions. Preoperative radiological examinations are useful for operative planning. Any anomalies to PCP can cause unnecessary injury to the neurovascular complex structure around the cavernous sinus or postclinoidectomy CSF fistulas. Posterior clinoidectomies should be avoided in patients with type III PCP pneumatization to prevent CSF fistulas.Öğe Evaluation of tendinosis of the long head of the biceps tendon by strain and shear wave elastography(Soc Romana Ultrasonografe Medicina Biologie-Srumb, 2018) Sahan, Mehmet Hamdi; Inal, Mikail; Burulday, Veysel; Kultur, TurgutAim: To investigate strain (SE) and shear wave elastography (SWE) characteristics of the long head of the biceps tendon (LHBT) tendinosis in comparison with magnetic resonance imaging (MRI) findings. Material and methods: Twenty patients with a MRI diagnosis of tendinosis and twenty healthy subjects with normal LHBT in MRI were prospectively examined by SE and SWE. SE color mapping was divided into four types in accordance with elasticity designs: type I predominantly blue (hardest tissue), type II predominantly blue-green (hard tissue), type III predominantly green (intermediate tissue), type IV predominantly green-yellow-red (soft tissue). Quantitative measurements of LHBT hardness with SWE were analyzed in kilopascals (kPa). Results: In the tendinosis group SE types in transverse scan were I in 24% of tendons, II in 50%, III in 25%, and in longitudinal scan I in 15%, II in 75%, and III in 10%. In the control group SE types in transversescan were II in 10% of tendons, III in 55%, IV in 35%, and in longitudinal scan II in 10%, III in 55%, and IV in 35%. SWE values in transverse scan were 38.32 +/- 7.2 kPa in the tendinosis group and 18.6 +/- 3.1 kPa in the control groupand in longitudinal scan 39.42 +/- 7.4 kPa in the tendinosis group, and 20.62 +/- 4.6 in the control group. There was a statistically significant difference in terms of elasticity patterns between the tendinosis and control groups (p<0.001). The receiver operating characteristic curve analysis was perfect and a cut-off value of tranverse 25.8 kPa and longitudinal, 24.6 kPa shear values had very high sensitivity and specificity for tendinosis. Conclusion: SE and SWE may be useful diagnostic tools for LHBT tendinosis when considering usability, cost effectiveness, and patient preference compared to MRI.Öğe Idiopathic Orbital Inflammatory Syndrome: Pseudotumor Orbita(2018) Taş, Burak Mustafa; Şimşek, Gökce; Onaran, Zafer; Burulday, Veysel; Kılıç, RahmiThe idiopathic orbital inflammatory syndrome (pseudotumor orbita) is an unexplained disease that mimicsthe complications of acute rhinosinusitis. Intense polymorphic lymphoid infiltration develops with inflammation. The masses in the orbita can be seen by 5% to 8%. It can cause nonspecific orbital symptoms, such as proptosis and swelling on eyelids. In our case, the patients presented to the eye outpatient clinic with swelling complaint and acute atopic conjunctivitis treatment was initiated but the patients who did not regression complaints were submitted. The patient’s magnetic resonance imaging (MRI) showed bilateral lateral rectus muscle thickening. Idiopathic orbital inflammatory syndrome (pseudotumor orbita) responded to the steroid treatment. Idiopathic orbital inflammatory syndrome (pseudotumor orbita) is benign, but can be confusedwith sinusitis complications with high morbidity and mortality.Öğe İDİYOPATİK PARKİNSON HASTALARINDA OLFAKTÖR BULBUS VOLÜM VE OLFAKTÖR SULKUS DERİNLİĞİNİN MANYETİK REZONANS GÖRÜNTÜLEME İLE DEĞERLENDİRİLMESİ(2019) Doğan, Adil; Burulday, Veysel; Alpua, MuratAmaç: Bu çalışmada idiopatik Parkinson hastalığı (İPH) olanbireylerde, olfaktör bulbus (OB) hacimleri ve olfaktör sulkus(OS) derinliğini incelemek amaçlandı.Gereç ve Yöntem: Bu çalışma retrospektif bir olgu kontrolçalışması olarak dizayn edildi. Manyetik rezonans görüntüleme(MRG) incelemeleri, standart bir kafa koili kullanılarak, 1.5-tesla MRG sistemi (Philips MRI Systems, Achieva Release 3.2Level 2013-10-21, Philips Medical) ile yapıldı. OB hacimhesaplamaları ve OS derinlik ölçümü için yağ baskılı T2Akoronal kesitler kullanıldı ve İPH grubundaki hastalarınverileri sağlıklı kontrol grubu ile karşılaştırıldı.Bulgular: Çalışmaya yaş ortalaması 69.07±10.48 yıl olan 39İPH hastası ile yaş ortalaması 69.57±10.12 yıl olan 40 sağlıklıkontrol dahil edildi. İPH hasta grubu ile kontrol grubukarşılaştırıldığında sağ (30.12±6.49, 39.13±6.55) ve sol(32.57±8.08, 38.17±4.96) OB hacimleri ile sağ (6.91±0.9,7.39±0.65) ve sol (6.82±0.7, 7.38±0.58) OS derinliklerininhasta grupta kontrollere göre belirgin olarak azaldığı görüldü.Sonuç: İPH hastalarında, OB hacimleri ve OS derinliklerininsağlıklı kontroller göre belirgin olarak azaldığı ve bu durumunhastaların tedavi ve yaşam kalitelerinin yönetimi açısındanönem taşıdığı sonucu ortaya çıkmıştır.Öğe The importance of medial-lateral styloid process angulation/coronal plane angle in symptomatic eagle syndrome(Wiley, 2017) Burulday, Veysel; Akgul, Mehmet Huseyin; Muluk, Nuray Bayar; Yagdiran, Burak; Inal, MikailWe used three-dimensional computerized tomography (3DCT) to obtain images of Eagle Syndrome (ES) cases and measurements of relevant variables. Twenty-five subjects with ES and 25 controls were included in this retrospective study. Styloid process length, anterior-posterior styloid process angulation (Sagittal plane angle) (APA), medial-lateral styloid process angulation (Coronal plane angle) (MLA), tonsil-stiloid distance and carotid-stiloid distance were measured on CT and 3DCT images, and cranial and neck angiography was obtained, from a total of 580 images. The styloid process lengths were 40.3 and 40.5 mm on the right and left sides in the ES group. The left MLA was lower in symptomatic (Median: 67.0 degrees) than asymptomatic (Median: 72.6 degrees) ES patients. In ES patients with styloid process length above 3 cm, MLA (coronal plane angle) is important, and the symptoms are more intense when this angle is smaller. Clin. Anat. 30:487-491, 2017. (c) 2017 Wiley Periodicals, Inc.Öğe Important landmarks and distances for posterior fossa surgery measured by temporal MDCT(SPRINGER, 2020) Burulday, Veysel; Bayar Muluk, Nuray; Komurcu Erkmen, Selmin Perihan; Akgul, Mehmet Huseyin; Ozdemir, AdnanIn this retrospective study, we aimed to present important anatomical structures and distances for posterior fossa surgery by temporal multidetector computed tomography (MDCT). The temporal MDCT images of 317 adult patients (158 males and 159 females) were retrieved from the hospital's picture archiving and communication system (PACS). In the coronal temporal MDCT views, the cochlea-carotid canal and jugular bulb-mastoid bone outer surface were measured. In the axial MDCT views, the carotid canal-jugular bulb and carotid canal-posterior fossa distances were measured; the carotid canal and jugular bulb anterior-posterior (AP) and transverse dimensions were also measured. The bilateral cochlea-carotid canal, jugular bulb-mastoid bone outer surface, and right carotid canal-jugular bulb distances were significantly greater in the males than those in the females (p < 0.05). The carotid canal-posterior fossa distance was not different in both genders (p > 0.05). The carotid canal-jugular bulb and the carotid canal-posterior fossa distances were greater on the left side than those on the right side in both genders (p < 0.05). In males, the outer surface distance was greater on the left jugular bulb-mastoid bone than that on the right side of that bone (p < 0.05). The difference between the carotid canal AP dimensions was not significant between males and females (p > 0.05). However, the carotid canal transverse dimension, jugular bulb AP, and transverse dimensions were significantly greater in the males than those in the females, bilaterally (p < 0.05). In each gender separately, the carotid canal AP and transverse dimensions were greater on the left side and the jugular bulb AP and transverse dimensions were greater on the right side than those on the left side (p < 0.05). Positive correlations were found between the cochlea-carotid canal, the jugular bulb-mastoid bone outer surface, and the carotid canal-jugular bulb distances as well as between the jugular bulb-mastoid bone outer surface and the carotid canal-posterior fossa distances (p < 0.05). In older patients, the carotid canal-posterior fossa distances were shorter on the left side (p < 0.05). Vascular and neural localizations should be well understood in the operative area before applying the surgical approach in the posterior fossa. Computed tomography (CT) has a greater role in the evaluation of bone structures and vascular canals in this area.Öğe İntrakranial Apselerde Cerrahi Tedavi Sonuçları(2016) Akgül, Mehmet; Burulday, VeyselGiriş: İntrakranyal apselerde cerrahi tedavi sonuçlarımızı sunmaktır. Gereç ve Yöntem: 2005-2016 tarihleri arasında Kırıkkale Üniversitesi Tıp Fakültesi Beyin ve Sinir Cerrahisi kliniğinde intrakranial abse tanısı ile tedavi edilen 11 olgu retrospektif olarak incelendi. Bu çalışmada, intrakranial apseli hastaların şikâyetleri, apsenin meydana geliş şekli, apsenin yerleşimi ve bulguların dağılımı incelendi. Hastalara uygulanan cerrahi yaklaşım şekilleri ve sonuçları karşılaştırıldı. Cerrahi teknik olarak Stereotaksik Burrhole'den aspirasyon veya kraniektomi ile drenaj ve kapsül eksizyonu uygulandı. Bulgular: Onbir hasta çalışmaya alındı. Hastaların yaşları 11-63 yaş arasındaydı. Ortalama yaş 333 idi. Hastaların şikayetleri, görülme sıklığına göre, 7 hastada (%63.6) bilinç bulanıklılığı, 4 hastada (%27.2) bulantı-kusma, daha az oranda baş ağrısı, kuvvetsizlik, ateş ve baş dönmesi şikayetleri vardı. Hastaların abse lokalizasyonları genellikle temporal semptomların başlaması sonrası kliniğimize başvuru süreleri, ortalama 23.65 gün'dü. Cerrahi olarak 11 hastanın 7'sine (%63.6) Burr-holle ile abse drenajı, 2 hastaya kraniektomi ile abse drenajı ve 2 hastaya kapsül eksizyonu (%18.1) operasyonu yapıldı. Operasyon öncesi ve sonrası radyolojik olarak Kranial Bilgisayarlı Tomografi (BT) çekildi. Klinik takipte laboratuar analizi olarak CBC, Sedimantasyon, hsCRP düzeylerine bakıldı. Operasyon sırasında abse materyalinden kültür gönderildi. Hastaların GOS (Glaskow outcome scala) puanlaması 8 hastada 5 (%72.7), bir hastada 4 (%9.09), bir hastada 2 (%9.09) ve bir hastada 1 (%9.09) puan olarak hesaplandı. Sonuç: İntrakranial abselerin cerrahisinde uygulanan cerrahi yaklaşımlardan abse aspirasyonu ile kapsül eksizyonu arasında GOS oranı açısından belirgin bir fark görülmedi. Ek olarak cerrahi sonrası takiplerde apse boyutun 2 cm'in altında ise Kranial BT takibine ihtiyaç olmadığı, medikal tedavi ve CRP düzeyi takibinin tek başına yeterli olduğu görüldü.Öğe Investigation of the calcification at the petroclival region through Multi-slice Computed Tomography of the skull base(Churchill Livingstone, 2016) Inal, Mikail; Muluk, Nuray Bayar; Burulday, Veysel; Akgul, Mehmet Huseyin; Ozveren, Mehmet Faik; Celebi, Umut Orkun; Daphan, Birsen UnalObjectives: The aim of this paper was a retrospective investigation of calcification at the petroclival region using Multi-slice Computed Tomography (MSCT). Methods: One hundred thirty skull bases were reviewed. The images were acquired with a 64 slice CT (MSCT). At first images were taken at the axial plane; and then coronal and sagittal reconstructions of raw data were performed. Later investigations were carried out on these 3-dimensional images (3-D imaging). Petrosphenoidal ligament (PSL) (Gruber's ligament) and posterior petroclinoid ligament (PPCL) calcifications were evaluated as "none, partial or complete calcification" for the right and left sides. Results: In the right PSL, there were partial calcifications in 9.8% and complete calcifications in 2.3%. Calcification ratio was 9.8% partial and 2.9% complete in the left PSL. In the right side, there were 26.6% partial and 5.2% complete calcifications of PPCL. In the left side, there were 29.5% partial and 4.6% complete PPCL calcifications.. PPCL calcification was detected more in males compared to females in the right and left sides. In older patients, left PSL; right and left PPCL calcification were detected more. Conclusion: PPCL calcifications cannot be differentiated from PSL calcifications in MSCT slices. The distinction can be easily done in 3-D views. The presence of ossified ligaments may make surgeries in this region difficult, and special care has to be taken to avoid injuries to structures which pass under these ossified ligaments. Particularly in elderly patients, the appropriate surgical instrument for the PSL calcifications should be prepared preoperatively. If PSL is calcified, 6th cranial nerve palsy may not occur even though increased intracranial pressure syndrome is present. Whereas, in lateral trans-tentorial herniations, 3rd cranial nerve palsy occurs in earlier periods when PSL is calcified. Moreover, in sub temporal and transtentorial petrosal approaches, knowing the PSL calcification preoperatively is important to avoid damaging the 6th cranial nerve during surgery. (C) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.Öğe Investigation of the prognostic value of blood parameters in patients with rinoserebral mucormycosis(2023) Demir, Ismail; Yalçın, Muhammed Zeki; Aydın, Sukru; Muluk, Nuray Bayar; Burulday, VeyselMucormycosis is a rapidly invasive, life-threatening opportunistic fungal infection, usually in immunocompromised patients. Suspicion, early diagnosis, debridement and anti-fungal treatment are important prognostic factors. The most common clinical manifestations of rhinocerebral mucormycosis are fever, headache, facial and ocular oedema. Invasion of surrounding tissues, the eye, skull base and brain is critical for disease progression. The purpose of this study was to investigate the predictive value of blood parameters in patients with mucormycosis. The preoperative 10-day blood parameters of 23 patients with clinical, radiological and pathological diagnoses of mucormycosis were compared in terms of etiology, gender and site of involvement. When the results were compared, the neutrophil-lymphocyte ratio (NLR) on days 1, 2, 5, 7, 8, 9, and 10 was significantly higher in patients with skull base involvement compared to those without skull base involvement (p<0.05). When comparing the regions of involvement, a significant correlation was found between cranial and turbinate involvement and between lamina papricea and ocular involvement (p<0.05). It was suggested that the NLR rate could be predicted as a poor prognostic factor in patients with mucormycosis.Öğe Is strain elastography beneficial for isoechoic cholangiocarcinomas?(Soc Romana Ultrasonografe Medicina Biologie-Srumb, 2016) Burulday, Veysel; Koc, Ural; Tan, Sinan…
