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    Bilateral Subdural Hematoma After Ventriculoperitoneal Shunt Surgery
    (Emergency Medicine Physicians Assoc Turkey, 2019) Yuksel, Ulas; Akkurt, Ibrahim; Ogden, Mustafa; Bakar, Bulent; Keskil, Semih
    Background: Bilateral subdural hematoma (SDH) following ventriculoperitoneal (V/P) shunt application was discussed in present case. Case Report: 8-year-old girl was operated due to thoracolumbar meningomyelocele immediately after birth. V/P shunt was inserted in right posterior parietal region due to hydrocephalus when she was 3 month-old. At age of 3 years, V/P shunt dysfunction was considered, and second V/P shunt was inserted in left posterior parietal region. One year after, patient was reevaluated, and CT images showed bilateral subacute SDH. Hematoma evacuation was not considered, but right ventricular catheter was ligated. At four years follow-up, no additional neurological impairment was observed in patient and CT scan revealed that SDHs were retracted greatly. Concusion: It should be kept in mind that SDH could develop after V/P shunt surgery. Additionally, it could be said that one of most important factor in determination of treatment of this complication was primarily neurological examination findings of patient.
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    Clinical experiences in neuronavigation
    (Ortadogu Ad Pres & Publ Co, 2007) Bademci, Gülşah; Berdan, Fatoş; Evliyaoğlu, Çetin; Keskil, Semih
    Objective: To evaluate the introduction of a neuronavigation system to our neurosurgical department as an increasingly important part of both planning and performing intracranial surgery. Material and Methods: From February 2005 to August 2006, 17 cranial neurosurgical operations with the aid of the Medtronic neuronavigation system were performed in the Department of Neurosurgery, Faculty of Medicine, University of Kirikkale. Duration of procedures, accuracy of targeting and processing the lesions, craniotomy spaces, duration of hospital stay, and postoperative neurologic status were evaluated. Results: Neuronavigation assisted operations accounted for 6.2% of elective surgeries in the selected time period. The mean deviation form accuracy for registration was 2.7 mm. Deep-seated small lesions comprised UP of the cases operated with neuronavigation assistance (33.3%). Although the duration of procedures and the duration of hospital stay seemed slightly higher for nueronavigation in comparison to the standard procedures it is more effective in the selection of the best position for the surgical approach, it reduces the time required for skin incision and craniotomy planning and cortex incision. Conclusion: Integration of high technology modalities to neurosurgery is becoming an increasingly used feature and provides useful information during surgery especially in small and multiple brain tumors located in eloquent brain areas.
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    In vivo human brain biochemistry after aerobic exercise: preliminary report on functional magnetic resonance spectroscopy
    (Elsevier Science Inc, 2005) Çağlar, Ertunga; Sabuncuoğlu, Hakan; Keskin, Tülay; Işıklı, Sedat; Keskil, Semih; Korkusuz, Feza
    Background: Our aim was to disclose whether the positive psychological changes observed after a single bout of aerobic exercise have a biochemical correlate that can be visualized by proton magnetic resonance spectroscopy (MRS) of the human brain. Methods: Right-handed male volunteers underwent psychological testing and MRS of the frontal lobe of the left hemisphere, both before and after 20 minutes of jogging at about 70% of their maximal aerobic capacity. Results: Although there was a significant decrease on the postexercise anxiety test scores (z = -2.201, P <.05), there was no significant difference between the preexercise and postexercise scores of positive and negative affect. Considering both "amplitude" and "area under the curve" values calculated for the peaks of metabolites N-acetylaspartate (NAA), creatine, and choline, none were found to be significantly changed (P >.05) after the exercise. Conclusion: This is, to our knowledge, the first study to report on a functional application of MRS to mood states. Because it offers the ability to directly measure metabolic changes in the brain during neuronal activation, "functional MRS" may be a potential new tool that may be used as an adjunct to functional magnetic resonance imaging. (c) 2005 Elsevier Inc. All rights reserved.
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    Pentylenetetrazol-induced seizures are not altered by pre- or post-drug exposure to a 50 Hz magnetic field
    (Taylor & Francis Ltd, 2007) Canseven, Ayşe G.; Keskil, Zuhal Aktuna; Keskil, Semih; Seyhan, Nesrin
    Purpose: To investigate whether pre- and post-drug magnetic field (MF) exposure of 50 Hz, 0.2 mT has any significant effect on pentylenetetrazol (PTZ)-induced seizures in mice. Material and methods: MF was generated by a pair of Helmholtz coils. Seizures were induced by PTZ injection intraperitoneally (i.p.) at a dose of 60 mg/kg. A total of 48 locally bred adult female mice 25 - 35 g in weight were used. Latency to seizure, total seizure duration, and mortality were recorded for each mouse. Results: Neither pre- nor post-drug exposure to a 50 Hz, 0.2 mT MF was found to have any effect on PTZ-induced epileptic seizures or mortality rates in mice. Conclusion: The present study failed to provide any support for a therapeutic potential of a 50 Hz, 0.2 mT MF for epilepsy.
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    Possible spontaneous "birth" of a hydatid cyst into the lateral ventricle
    (Springer, 2005) Evliyaoğlu, Çetin; Keskil, Semih
    Introduction: Intraventricular hydatid cyst is an extremely rare entity. We report a solitary hydatid cyst in a lateral ventricle. Case report: A 7-year-old girl had a free floating intraventricular cyst, diagnosed by computerized tomography examination inside the enlarged left lateral ventricle of an associated Dandy Walker malformation. The patient underwent surgery and the cyst was removed. Conclusion: To our knowledge, this is the first case report in which the natural developmental phases of an intraventricular hydatid cyst have been observed.
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    POTT DISEASE MIMICKING A SPINAL TUMOR: A CASE REPORT
    (Kırıkkale Üniversitesi, 2017) Yüksel, Ulaş; Akgül, Mehmet Hüseyin; Öğden, Mustafa; Atasoy, Pınar; Keskil, Semih
    Delays in the diagnosis and treatment of spinal tuberculosis may leadto vertebral fracture and spinal cord compression that may cause to the secondarypersistent neurological loss and spinal deformity.52 year-old man admittedto hospital with progressive back pain and paraparesis. There was weigth loss withoutnigth fewer or nigth sweiting in his past history. His neurological exam revealedparaparesisand hypoesthesia under the T9 level. There was pathologic collaps a fracture and kyphosis inT8 and T9 vertebrae in his radiological images. In laboratory tests C-reactiveprotein and sedimentation values ??were close to normal. He was underwent stabilisationsurgery and histopatological exam of the tissue specimens revealed caseificationnecrosis. On follow-up, patient's neurological symptoms were delayed at fourth postoperativemonth and returned to normal daily life at the end of the third year. Pott disease should alsobe considered in pathological vertebral fractures even without weight loss,night sweats, fever.
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    Pott Disease Mimicking a Spinal Tumor: A Case Report
    (2017) Yüksel, Ulaş; Akgül, Mehmet Hüseyin; Öğden, Mustafa; Atasoy, Pınar; Keskil, Semih
    Spinal tüberkülozun tanı ve tedavisindeki gecikmeler bu hastalığa bağlı gelişebilecek komplikasyonlara (omurga kırığı, epidural apse gibi) ikincil omurilik basılarına ve kalıcı nörolojik kayıplara ve omurgada şekil bozukluğuna yol açabilmektedir. 52 yaşında erkek hasta, bir yıldır ilerleyici ve artan vasıfta sırt ağrısı ve bacaklarda güçsüzlük şikayetleri ile gelen hastanın öyküsünde ateş ve gece terlemesi olmamasına rağmen kilo kaybı vardı. Nörolojik muayenesinde alt ekstremite kas gruplarında 2/ 5 kuvvet kaybı ve T9 seviyesi altında ileri hipoestezi saptandı. Yapılan radyolojik görüntüleme tetkiklerinde T8 ve T9omurlarındaspinal kanalı daraltan patolojik çökme kırığı ve kifoz tespit edildi. Laboratuar tetkiklerinde C-reaktif protein ve sedimantasyon değerleri normale yakındı. Mevcut güç kaybı ve radyolojik bulgular nedeniyle ameliyat edilen hastanın doku patolojisinde nekrozitan granülomlar ve kazeifikasyon nekrozu görülmesi üzerine anti-tüberküloz tedavi başlandı. Hastanın takibinde ameliyat sonrası dördüncü ayda nörolojik bulgularının düzelmeye başladığı ve üçüncü yılın sonunda normal günlük hayatına döndüğü gözlendi. Sonuç olarak, günümüzde nadir görünmekle birlikte patolojik omurga kırığı düşünülen hastalarda tüberküloz ve Pott hastalığı da akla getirilmelidi.
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    Pott's puffy tumor of the vertex years after trauma in a diabetic patient: case report
    (Sociedad Luso-Espanola Neurocirugia, 2005) Evliyaoğlu, Çetin; Bademci, Gülşah; Yücel, Engin; Keskil, Semih
    Pott's puffy tumor is a rare clinical entity characterized by subperiosteal abscess associated with osteomyelitis. It is usually seen as a complication of frontal sinusitis or trauma. This is the unique report of a Pott's puffy tumor located over the vertex of a type 1 diabetic patient with an unusual latency of 14 years following injury. A 27-year old man presented with pain and a soft swelling on his vertex. Magnetic resonance imaging demonstrated subperiosteal abscess in the vertex region associated with dural thickening and perisinusal irregularities of epidural space. Further history revealed that he had a trauma to the same location when he was 13 years old. Considering possible complications due to proximity of the lesion to the sagittal sinus, we retrained from aggressive surgical interventions. We treated our patient with a simple surgical abscess drainage followed by prolonged use of antibiotics and achieved complete therapy. The cellular and humoral elements of the immune system may be disrupted in diabetic patients resulting in such atypical courses and complications of infections. We want to emphasize both importance of the prompt diagnosis of Pott's puffy tumor as intracranial invasion may cause severe neurologic problems, and importance of a surgical intervention tailored for the individual lesion.
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    Proximally situated osseous septum in complex spina bifida - Case report
    (Amer Assoc Neurological Surgeons, 2005) Bademci, Gülşah; Evliyaoğlu, Çetin; Keskil, Semih
    In Type I split cord malformation (SCM) lesions, the osteocartilaginous spur and its dural sleeve are almost always located in the caudal extent of the median cleft. The authors present a case of lumbar myelomeningocele associated with a thoracic Type I SCM in which an osseous septum is uniquely situated in the proximal extent of the median cleft. Split cord malformations are cord-tethering lesions, which may be associated with a myelomeningocele that causes additional tethering, even in the opposite direction; therefore, both lesions should be treated. In view of this unique case, however, the surgical approach used for tethering lesions in such cases of complex spina bifida should perhaps be tailored. Whenever feasible, meticulous preoperative examination of a patient with spina bifida, including entire craniospinal magnetic resonance imaging followed with perioperative dynamic evaluation, is important for the effectiveness and safety of the surgery.
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    Transoral screw and wire fixation for unstable anterior 1/2 atlas fracture
    (Medknow Publications & Media Pvt Ltd, 2017) Keskil, Semih; Goksel, Murat; Yuksel, Ulas
    Study Design: Atlas fractures are evaluated according to the fracture type and ligamentous injury. External immobilization may result in fracture nonunion. Objective: The ideal treatment method for non-stabilized atlas fractures is limited fixation without restricting the range of motion of the atlantoaxial and atlantooccipital joints. Summary of Background Data: Such a result can be established by using either anterior fixation or posterior lateral mass fixation. However, none of these techniques can fully address anterior 1/2 atlas fractures such as in this case. Materials and Methods: A transoral technique in which bilateral screws were placed intralaminarly and connected with wire was used to reduce and stabilize an anterior 1/2 fracture of C1. Result: Radiological studies after the surgery showed good cervical alignment, no screw or wire failure and good reduction with fusion of anterior arcus of C1. Conclusions: Internal immobilization by this screw and wire osteosynthesis technique protects the mobility of the atlanto-occipital and atlantoaxial joints. The main advantage is that neither the twisted wires inserted under the anterior lamina, nor the laterally placed screw heads interfere with midline wound closure; unlike the plate/cage and rod systems used together with anterior screws. A computer navigation system with intraoperative 3D imaging facilities will be of benefit for safe placement of the screw, however we preferred a free-hand technique, as the starting point was at the fracture line along the trajectory of the routinely accessible anterior lamina.
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    Unilateral isolated alar ligament rupture in an adult female patient
    (Kare Publ, 2021) Keskil, Semih; Yuksel, Ulas; Bilgili, Yasemin Karadeniz; Babacan, Avni
    Only seven cases of isolated unilateral rupture of the alar ligament had been previously reported. The authors report the first adult female case of this rare injury. The patient in their case, a 36-year-old female presented after a trauma due to falling, and at that moment, she had fainted due to a sudden pain between the neck and head. The radiological examinations [magnetic resonance imaging (MRI) and X-rays] had been interpreted as normal. She had a positive Alar ligament test at the right side, and a thin section craniovertebral junction computed tomography was obtained which revealed an asymmetrically left-sided odontoid process and a new MRI revealed a right-sided alar ligament rupture. Th us she underwent a bilateral greater occipital nerve block together with pulse radiofrequency and trigger point injection at splenius capitis, levator scapula, and trapezius followed by the application of a halo orthosis to be worn for 3 months. The patient was found to be pain-free in the follow-up examinations. With pure unilateral alar ligament rupture, the atlantooccipital joint is not disrupted and the craniovertebral junction is not destabilized. To date, only eight cases of isolated unilateral alar ligament rupture have been reported one of which was a 25 years old male; all of whom presented with marked neck pain and treated by external immobilization for 4 weeks to 4 months and our case is the first adult female patient.
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    Unilateral lag-screw technique for an isolated anterior 1/4 atlas fracture
    (Medknow Publications & Media Pvt Ltd, 2016) Keskil, Semih; Goksel, Murat; Yuksel, Ulas
    Study Design: Fractures of the atlas are classified based on the fracture location and associated ligamentous injury. Among patients with atlas fractures treated using external immobilization, nonunion of the fracture could be seen. Objective: Ideally, treatment strategy for an unstable atlas fracture would involve limited fixation to maintain the fracture fragments in a reduced position without restricting the range of motion (ROM) of the atlantoaxial and atlantooccipital joints. Summary of Background Data: Such a result can be established using either transoral limited internal fixation or limited posterior lateral mass fixation. However, due to high infection risk and technical difficulty, posterior approaches are preferred but none of these techniques can fully address anterior 1/4 atlas fractures such as in this case. Materials and Methods: A novel open and direct technique in which a unilateral lag screw was placed to reduce and stabilize a progressively widening isolated right-sided anterior 1/4 single fracture of C 1 that was initially treated with a rigid cervical collar is described. Results: Radiological studies made after the surgery showed no implant failure, good cervical alignment, and good reduction with fusion of C 1 . Conclusions: It is suggested that isolated C 1 fractures can be surgically reduced and immobilized using a lateral compression screw to allow union and maintain both C 1-0 and C 1-2 motions, and in our knowledge this is the first description of the use of a lag screw to achieve reduction of distracted anterior 1/4 fracture fragments of the C1 from a posterior approach. This technique has the potential to become a valuable adjunct to the surgeons armamentarium, in our opinion, only for fractures with distracted or comminuted fragments whose alignment would not be expected to significantly change with classical lateral mass screw reduction.