Perkütan lazer disk dekompresyonu: 197 olgunun retrospektif analizi ve literatürün taranması

AIM: Percutaneous laser disc decompression (PLDD) is a one of the well-known minimal invasive treatment methods of disc herniations. The aim of this study is to present our clinical experience and to show the benefits of this technique. MATERIAL and METHODS: A total of 197 patients, who met the criteria of PLDD, underwent treatment between 2007 and 2009. The data of the patients was reviewed retrospectively. Among them, 107 (54.3 %) patients were male and 90 were female with a mean age of 46.34 years (ranged between 23 and 86 years). Seventy-two patients underwent one level PLDD, 112 (56.8 %) patients two levels PLDD and 13 patients three levels PLDD procedures. The mean follow-up time was 42 months. RESULTS: Among the 72 patients, the level of PLDD was L3-L4 in 4 patients, L4-L5 in 39 patients and L5-S1 in 29 patients. L4-L5 and L5-S1 levels were the most common 2-level PLDD locations in 71 patients. Twenty-five (12.7 %) patients underwent microsurgical discectomy after PLDD. The procedure was repeated in 3 patients. Discitis secondary to possible thermal injury occurred in 2 (0.1%) patients and this complication was improved with conservative treatment. CONCLUSION: PLDD is a safe and effective procedure in the treatment of discogenic pain if the patient met the selection criteria. However, this technique is not an alternative to open surgery

In-situ cranioplasty after microvascular decompression: A technical note

Cranioplasty is not only performed for cosmetic reasons but also for physiological requirements to balance the cerebral hemodynamics and to protect the brain from external traumas. Methyl methacrylate is one of the most preferred materials for cranioplasty. It is usually prepared out of the surgical site and therefore modelling of the cranioplasty material to fit the bone defect is sometimes difficult. In this technical note, we present our new technique of cranioplasty with methyl methacrylate in which the material is prepared on site of the bone defect and very easily shaped. Fixation materials are not needed. This technique is especially suitable for posterior fossa surgeries after craniectomy

Dejeneratif spondilolistezis, spinal stenoz, lomber kompresyon fraktürü olan yüksek riskli hastalarda spinal anestezi ile posterior lomber stabilizasyon cerrahisi

AIm: Spinal anesthesia is an appropriate technique for lumbar spine surgeries of two to three hours duration. The aim of this study is todocument our experience on spinal anesthesia administered to the patients with degenerative lumbar spine.Ma terIal and Methods: A total of 497 patients underwent spinal stabilization surgery with spinal anesthesia for degenerative lumbarspinal disorders in an 8-year period. Spinal anesthesia was performed at the L3-L4 or L4-L5 level and subarachnoid block was achieved with15 mg of 0.5% plain bupivacaine with 2 µg of fentanyl and 0.2 mg of epinephrine. There was no failure of anesthesia. The patients wereclosely monitored for complications associated with the SA technique and especially hypotension and bradycardia but no gross alterations incardiovascular stability were noted.Results: Among the 497 patients, 139 were male and 358 were female with a median age of 51 years. The average anesthesia durationwas 130 minutes and the average operative time was 85 minutes. In the postoperative period 36 patients has nausea (7.2%) and 18 of themhad vomiting (3.6%) that required one dose of antiemetic. No spinal headache was observed and 36 (7.2%) patients complained of urinaryretention. All recovered with urinary cannulation within 24 hours. No respiratory complication occurred and no patient died.ConclusIon: Spinal anesthesia is a safe and effective procedure for the lumbar spinal stabilization surgery, especially in high-riskpatients.Proper precautions should be taken in order to achieve an effective anesthesia for these operations

A clinical analysis of microvascular decompression surgery with sacrification of the superior petrosal venous complex for trigeminal neuralgia a single-surgeon experience

AIM: To report the surgical outcomes in patients with trigeminal neuralgia (TN) who underwent microvascular decompression (MVD) with superior petrosal vein sacrification. MATERIAL and METHODS: Data from 63 patients, whose information was obtained from a group of 113 patients who underwent surgery from 2008 to 2018, were reviewed retrospectively by the first author who was not part of the surgical team, and the pain conditions were evaluated objectively. RESULTS: Following surgery, pain relief occurred in 84% of patients during the early postoperative period and in 69.8% of patients during long-term follow-up. The major offending vessel was the superior cerebellar artery. CONCLUSION: MVD surgery, in particular for patients with typical pain, is one of the most effective treatment strategies for TN. Superior petrosal vein sacrification is a safe method that helps neurosurgeons to visualise the surgical area and perform a better work-up. Neurosurgeons should not be afraid to carry out superior petrosal vein sacrification

Percutaneous Laser Disc Decompression: Retrospective Analysis of 197 Cases and Review of The Literature

AmAÇ: Perkütan lazer disk dekompresyonu (PLDD) disk hernilerinin tedavisinde iyi bilinen minimal invaziv bir yöntemdir. Çalışmanın amacı PLDD konusunda klinik tecrübemizi paylaşmak ve bu tekniğin faydalarını göstermektir. yÖntem ve GereÇler: 2007 ile 2009 yılları arasında kriterlere uyan 197 hastaya PLDD uygulanmıştır. Bu 197 hastanın verileri retrospektif olarak incelendi. Olguların 107 (% 54,3)'si erkek ve 90'ı kadın olup, ortalama yaş 46,34'dü (23-86 yaş arası). Yetmiş iki hastaya tek seviye, 112 (% 56,8) hastaya iki seviye ve 13 hastaya üç seviye PLDD uygulandı. Ortalama takip süresi 42 ay idi. BulGulAr: 72 hasta içinde, 4 hastada L3-L4 seviyesine, 39 hastada L4-L5 seviyesine ve 29 hastada L5-S1 seviyesine PLDD uygulandı. L4-L5 ve L5-S1 seviyesi en sık 2-seviye PLDD uygulanan seviyedir ve 71 hastaya uygulanmıştır. Yirmibeş (% 12,7) hastaya PLDD'den sonra mikrocerrahi yöntemle diskektomi uygulanmıştır. Üç hastada prosedür tekrar uygulanmıştır. Muhtemel termal hasara sekonder diskitis 2 (% 0,1) hastada izlenmiştir ve bu komplikasyon konservatif yöntemle düzelmiştir. sOnuÇ: Perkütan lazer disk dekompresyonu hasta kriterlere uyduğu takdirde güvenli ve etkin bir tedavi yöntemidir. Ancak bu teknik hiçbir zaman açık cerrahiye alternatif değildir.AIm: Percutaneous laser disc decompression (PLDD) is a one of the well-known minimal invasive treatment methods of disc herniations. The aim of this study is to present our clinical experience and to show the benefits of this technique. mAterIAl and methOds: A total of 197 patients, who met the criteria of PLDD, underwent treatment between 2007 and 2009. The data of the patients was reviewed retrospectively. Among them, 107 (54.3 %) patients were male and 90 were female with a mean age of 46.34 years (ranged between 23 and 86 years). Seventy-two patients underwent one level PLDD, 112 (56.8 %) patients two levels PLDD and 13 patients three levels PLDD procedures. The mean follow-up time was 42 months. results: Among the 72 patients, the level of PLDD was L3-L4 in 4 patients, L4-L5 in 39 patients and L5-S1 in 29 patients. L4-L5 and L5-S1 levels were the most common 2-level PLDD locations in 71 patients. Twenty-five (12.7 %) patients underwent microsurgical discectomy after PLDD. The procedure was repeated in 3 patients. Discitis secondary to possible thermal injury occurred in 2 (0.1%) patients and this complication was improved with conservative treatment. COnClusIOn: PLDD is a safe and effective procedure in the treatment of discogenic pain if the patient met the selection criteria. However, this technique is not an alternative to open surgery

Microvascular Decompression in Trigeminal Neuralgia

Fasial ağrı sendromları içerisinde trigeminal nevralji en sık karşılaşılan sendromdur. Mikrovasküler dekompresyon trigeminal nevraljide oldukça etkili bir yöntemdir. Trigeminal nevraljide cerrahi dışı bulgular Gasser ganglionun alınması, meckel cave içine alkol enjeksiyonu, Gasser ganglionunun perkutan yolla koagülasyonu, balon kateter gibi yöntemler kullanılmaktadır. Bu yöntemlerle ağrı kontrolü belirli süre ile mümkün olduğundan kalıcı ağrı kontrolü için mikrovasküler dekompresyon en iyi yöntemdir. Trigeminal sinire en sık Süperior serebellar arter basısı mevcut olup daha az oranda ven ve arter ile ven kombine basısı da oluşabilmektedir. Uygun yöntemlerle yapılan mikrovasküler dekompresyon cerrahisi uzun dönemde %90 lara varan ağrı kontrolü sağlayan güvenli bir yöntemdir.Trigeminal neuralgia is most frequent facial pain syndrome. Microvascular decompression is a quite effective procedure for the treatment of trigeminal neuralgia. In the non-surgical treatment of trigeminal neuralgia, excision of the gasserian ganglion, alcohol injection into the Meckel’s cave, percutaneous coagulation of the gasserian ganglion, and destruction of the gasserian ganglion by balloon catheter application are the procedures used. Pain control can be possible for a while with these procedures but microvascular decompression is the best method for permanent pain control. Superior cerebellar artery compression of the trigeminal nerve is most frequently seen, but less frequently the reason can be vein compression or both vein and artery combined compression. Microvascular decompression can provide 90% pain control in the long term if the appropriate surgical technique is used

Rare cervical meningomyelocele in newborn

Nöral tüp defektleri (NTD), medulla spinalis ve kraniyumu kapsayan ve yenidoğan döneminde en sık saptanan konjenital malformasyonlardan birisidir. Nöral arkın kapanmasının tam gerçekleşememesi nedeni ile meningomyelosel, meningosel, spina bifida okülta, sirengomiyeli, dermal sinüs traktı ve tethered kord gelişebilmektedir. Yenidoğanda meningomyelosel yaygın görülebilmekte, genellikle folik asit eksikliği, genetik eğilim ve gebelik sürecinde alınan bazı ilaçlara bağlı oluşabilmektedir. Genellikle, lumbosakral bölgede görülür, servikal bölge lokalizasyonu nadirdir. Doğum sonrası, servikal bölgede kese görülmesi üzerine servikal magnetik rezonans (MR) görüntüleme ile değerlendirilen ve servikal meningomyelosel tesbit edilen yenidoğan kız bebek meningomyelosel lokalizasyonunun servikal bölgede olması ve nadir görülmesi nedeni ile sunmayı uygun gördük.Neural tube defects (NTD) are one of the most frequently seen congenital malformations covering the spinal cord and cranium in the neonatal period. Myelomeningocele, meningocele, spina bifida occulta, syringomyelia, dermal sinus tract and tethered cord can develop due to incomplete neural arch closure. Meningocele is commonly seen in newborns. It may occur usually due to folic acid deficiency, a genetic tendency and certain drugs taken during pregnancy. It is usually seen in the lumbosacral region but the cervical region is a rare localization. A newborn baby girl was evaluated by cervical magnetic resonance (MR) imaging. The MR findings show cervical myelomeningocele sac and she is diagnosed as having myelomeningocele. We present the case, due to localization of the meningomyelocele and its rarity

Tümüyle intraventriküler yerleşimli glioblastoma

Tümüyle intraventriküler yerleşimli glioblastomaGlioblastoma (GBM) en sık görülen primer malign beyin tümörüdür ve genellikle supratentorial beyin parenkimine yerleşir. Tümüyle intraventriküler yerleşim oldukça nadirdir. 48 yaşında tümüyle intraventriküler yerleşimli GBM'li bir erkek hastayı sunduk. Hastaneye baş ağrısı ve bulantı-kusma ile başvurmuştu ve manyetik rezonans görüntüleme tümüyle lateral ventrikülün sol oksipital hornuna yerleşmiş bir kitle lezyonunu ortaya çıkardı. Tümör sol oksipital kraniotomi ile gros total olarak çıkartıldı. Histolojik inceleme GBM tanısını doğruladı. GBM intraventriküler kitle lezyonlarının ayırıcı tanısında akılda tutulmalıdır. Doğru tanı ve hızlı cerrahi müdahale intraventriküler GBM'si olan hastalarda iyi bir klinik sonuç elde etmek için gereklidirGlioblastoma (GBM) is the most common primary malignant brain tumor and it is usually located within the supratentorial brain parenchyma. Pure intraventricular location is extremely rare. We presented a 48-year-old male patient with pure intraventricular GBM. He was admitted to our hospital with headache and nauseavomiting and the magnetic resoanance imaging revelaed a mass lesion purely located into the left occipital horn of the lateral ventricle. The tumor was removed gross totally via left occipital craniotomy. The histological examination confirmed the diagnosis of GBM. GBM should be kept in mind in the differential diagnosis of intraventricular mass lesions. Accurate diagnosis and prompt surgical intervention are required to achieve good clinical outcome in patients with intraventricular GB

Analysis of proximal radial nerve injury in the arm

Background: Radial nerve is the most frequently injured major nerve in the upper extremity. Proximal part of the radial nerve involvement can result from a humerus fracture, direct nerve trauma, compression and rarely from tumors. Objectives: The aim of the study is to determine the clinical characteristics and electrodiagnostic findings in patients with proximal radial nerve injuries, and also the outcome of surgical treatment. Materials and Methods: The study subjects included 46 patients with radial nerve injuries seen between June 2000 and June 2008 at our hospital. The analysis included demographics, clinical features, etiology, pre-and postoperative EMNG (Electromyoneurography) findings. Results: Surgical decompression resulted in neurological improvement in patients with radial entrapment neuropathies. Good neurological recovery was observed from decompression of callus of old humeral fracture. The worst results were observed in the direct missile injuries of the radial nerve. Conclusions: A detailed clinical and electrodiagnostic evaluation is of importance in patients with radial nerve injury to ensure an appropriate treatment. The choice of treatment, conservative or surgical, depends on the clinical presentation and the type of injury

The importance of preoperative planning to perform safely temporal lobe surgery

Neurosurgeons should know the anatomy required for safe temporal lobe surgery approaches. The pre-sent study aimed to determine the angles and distances necessary to reach the temporal stem and tem-poral horn in surgical approaches for safe temporal lobe surgery by using a 3.0 T magnetic resonance imaging technique in post-mortem human brain hemispheres fixed by the Klingler method. In our study, 10 post-mortem human brain hemisphere specimens were fixed according to the Klingler method. Magnetic resonance images were obtained using a 3.0 T magnetic resonance imaging scanner after fixa-tion. Surgical measurements were conducted for the temporal stem and temporal horn by magnetic res-onance imaging, and dissection was then performed under a surgical microscope for the temporal stem. Each stage of dissection was achieved in high-quality three-dimensional images. The angles and distances to reach the temporal stem and temporal horn were measured in transcortical T1, trans-sulcal T1-2, transcortical T2, trans-sulcal T2-3, transcortical T3, and subtemporal trans-collateral sulcus approaches. The safe maximum posterior entry point for anterior temporal lobectomy was measured as 47.16 +/- 5.0 0 mm. Major white-matter fibers in this region and their relations with each other are shown. The dis-tances to the temporal stem and temporal horn, which are important in temporal lobe surgical interven-tions, were measured radiologically, and safe borders were determined. Surgical strategy and preoperative planning should consider the relationship of the lesion and white-matter pathways. (c) 2021 Elsevier Ltd. All rights reserved