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    Decompressive Craniectomy for Intractable Intracranial Hypertension
    (Derman Medical Publ, 2012) Baka, Bulent; Sumer, Mehmet Murat; Tekkok, Ismail Hakki
    Aim: This retrospective study was established to analyse the effects of the decompressive craniectomy on patients with different causes of increased intracranial pressure. Material and Method: Nine patients at risk of developing malignant cerebral edema aged between 18 and 75 years were included in this study. Four patients suffered from severe traumatic brain injury, two patients from subarachnoid haemorrhage (SAH) and vasospastic ischemia, and 3 patients from malignant infarction of the middle cerebral artery. Results: Nine patients underwent decompressive craniectomy as the last therapeutic choice. At first admission mean intracranial pressure (ICP) was 22.6 +/- 6.7 mmHg; mean preoperative ICP value was 40.8 +/- 16.3 mmHg; and mean postoperative ICP value was 9.3 +/- 3.6 mmHg. In two patients bilateral; and in seven patients unilateral frontotemporoparietal craniectomy was preferred. Mean time of the re-implantation of the bone flap was 25.75 +/- 10.0 days. One patient with SAH died postoperatively and eight patients survived (mortality rate 11.1%). Mean value of the Glasgow Outcome Scale score as evaluated at 36 months after the decompression was approximately 4. Discussion: This surgical procedure is successful for treatment of the acute or delayed intractable intracerebral hypertension with a low rate of complication if it is performed timely and carefully.
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    External Carotid-Internal Jugular Fistula as a Late Complication After Carotid Endarterectomy: A Rare Case
    (Springer, 2011) Bakar, Bulent; Cekirge, Saruhan; Tekkok, Ismail Hakki
    A 66-year-old man presented with mild amnesia, progressive fatigue, ataxia, visual hallucinations, and debility. His past medical history included right-sided carotid endarterectomy performed elsewhere 6 years previously. Cranial magnetic resonance imaging showed left parieto-occipital arteriovenous malformation-like tortous vessels, venous congestion, and ischemic areas. Cerebral angiography showed right-sided compound external carotid artery-internal jugular vein (IJV) fistula, and distal occlusion of the right IJV. Transvenous embolization via contralateral IJV was performed, and the fistula, together with fistulous portion of the distal IJV, was sealed using coils. Two years later, patient is well with normal neurologic examination findings. The presence of an arteriovenous communication after vascular surgery is a serious complication with potential long-term effects and therefore should be diagnosed and treated as promptly as possible.
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    Far Lateral Disc Herniation Evaluated by Coronal Magnetic Resonance Imaging: Case Series
    (Turkish Neurosurgical Soc, 2015) Bakar, Bulent; Tekkok, Ismail Hakki
    The extent of the slice thickness in spinal axial and sagittal magnetic resonance imaging (MRI) is limited. We therefore, propose the idea of using coronal MRI to better delineate lumbar far lateral disc herniations. Six patients with coronal MR images who underwent surgery are presented in this study. Simple 2D vertebral column X-ray and MRI scans were used to diagnose the far lateral herniated disc. Intraoperative findings confirmed our preoperative MRI diagnosis in all patients. Recovery was excellent in all patients. In conclusion, corona! lumbar MRI, a simple and useful technique to reveal the nerve roots in foraminal and/or far lateral (extraforaminal) areas, is a must for accurate diagnosis of foraminal and/or far lateral lumbar disc herniations.
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    Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labour
    (Elsevier Science Inc, 2015) Bakar, Bulent; Ozer, Esra; Tekkok, Ismail Hakki
    Background and objectives: Only few reports in literature have pointed out to the possibility of a cranial subdural haematoma formation associated with dural puncture during spinal or epidural analgesia. We herein describe such a rare case who was diagnosed to have acute subdural haematoma after combined spinal-epidural anaesthesia used in labour. Case report: A 34-year-old, primigravid women with a gestation of 38 weeks underwent caesarean section under combined spinal-epidural anaesthesia and gave birth to a healthy boy. Thirty-two hours after delivery, her moderate headache progressed to a severe headache associated with nausea and vomiting and later was more complicated with a generalized tonic-clonic seizure and ensuing lethargy. Computed tomography of the brain demonstrated a right-sided fronto-temporo-parietal acute subdural haematoma with diffuse cerebral oedema. She underwent urgent FTP craniotomy and evacuation of the haematoma. Early postoperative cranial computed tomography showed a clean operative site. Eight days after subdural haematoma surgery, she became lethargic again, and this time cranial computed tomography disclosed an extradural haematoma under the bone flap for which she had to undergo surgery again. Two days later, she was discharged home with Karnofsky performance score of 90/100. At follow-up exam, she was neurologically intact and her cranial computed tomography and magnetic resonance were normal. Conclusions: As conclusion, with the use of this combined spinal-epidural anaesthesia, it should be kept in mind that headache does not always mean low pressure headache associated with spinal anaesthesia and that a catastrophic complication of subdural haematoma may also occur. (c) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
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    Plasmocytoma of the Skull Vault
    (Turkish Neurosurgical Soc, 2012) Bakar, Bulent; Tekkok, Ismail Hakki
    AIM: Plasma cell tumours include solitary plasmocytoma, multiple plasmocytoma and multiple myeloma. Herein we report a case of plasmocytoma of the skull. CASE HISTORY: A 49 year-old-man suffered from amnesia, irritability and a rubbery swelling which was gradually increased approximately to 4-5 cm in diameter at the frontal vertex over a year. His neurological examination was normal. The skull direct X-ray revealed patchy destruction of the left frontal bone 10 cm in diameter. CT with bone windows showed relatively preserved but severely thinned inner table and irregularly destructed outer table. MR scan showed a hypervascular, mainly solid mass measuring 9x5.5x8.5 cms. Radical surgery consisting of total tumour extirpation was undertaken. Histopathological examination confirmed a plasmocytic proliferation. The postoperative period was uneventful and the patient was discharged on the 6th day postoperatively. Bone marrow sampling was scheduled to rule out multiple myeloma, but the patient committed suicide a week later for reasons not known to us. CONCLUSION: Although the prognosis of a plasmocytoma is relatively good, this study demonstrated that patients with ventral frontal cortex tumour may have significantly worse mood pre- or postoperatively. Clinicians should therefore be careful in the follow-up period.