Browsing by Author "Korfali, Ender"

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Analysis of intracranial pressure changes during early versus late percutaneous tracheostomy in a neuro-intensive care unit
(Springer, 2008-12) Kocaeli, Hasan; Korfali, Ender; Taşkapilioğlu, Özgür; Özcan, Tekin; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; V-1196-2018; 6603500567; 7004641343; 6506852772; 25636374000
Background We aimed to investigate intracranial pressure (ICP) changes during early versus late bedside percutaneous tracheostomy (PT) in a neuro-intensive care unit (NICU). Methods This study included 30 patients admitted to our NICU for head trauma, subarachnoid haemorrhage, intracerebral haematoma or brain tumour with a Glasgow Coma Score (GCS) less than 8. These patients also underwent ICP monitoring. Bedside PT was performed either early (within 7 days of ventilation) or late (after 7 days of ventilation) via the Griggs system. In all patients; ICP, systemic blood pressure, heart rate, oxygen saturation (Sat O(2)) and arterial blood gases were recorded 5 min before the procedure, during skin incision, during tracheal cannulation, as well as 5 min and 10 min after the procedure. Findings Thirty patients, 18 male and 12 female, with various intracranial pathologies between ages 18 and 78 (mean 38.7 +/- 20) were identified. The admission GCS ranged between 4 and 11 (median 7). Physiological variables did not differ significantly between the two groups. In the early group, ICP values measured 5 min before the procedure, during skin incision, during tracheal cannulation, as well as 5 min and 10 min after the procedure were 15.1 +/- 5.2, 22 +/- 10.1, 28.4 +/- 13.7, 17.3 +/- 7.1, 13.8 +/- 5.0 mmHg, respectively. In the late group, these values were 14.2 +/- 4.5, 17.2 +/- 5.5, 21.5 +/- 8.0, 15.1 +/- 5.3 and 12.4 +/- 4.1 mmHg. There was no significant difference between the early or late groups in terms of ICP increases during these predetermined 5 time points. Conclusions In patients with decreased intracranial compliance, a relatively minimally invasive procedure such as PT may lead to significant increases in ICP. The timing of PT does not seem to influence ICP, mortality, pneumonia or early complications. During the PT procedure, ICP should be closely monitored and preventive strategies should be instituted in an attempt to prevent secondary insult to an already severely injured brain.
Citicoline and postconditioning provides neuroprotection in a rat model of ischemic spinal cord injury
(Springer Wien, 2010-06) Türkkan, Alper; Alkan, Tülin; Gören, Bülent; Kocaeli, Hasan; Akar, Eylem; Korfali, Ender; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Fizyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Patoloji Anabilim Dalı.; AAH-1792-2021; AAH-1718-2021; 25029159600; 6601953747; 6602543716; 6603500567; 26634688200; 7004641343
Ischemic spinal cord injury is a chain of events caused by the reduction and/or cessation of spinal cord blood flow, which results in neuronal degeneration and loss. Ischemic postconditioning is defined as a series of intermittent interruptions of blood flow in the early phase of reperfusion and has been shown to reduce the infarct size in cerebral ischemia. Our study aimed to characterize the relationship between the neuronal injury-decreasing effects of citicoline and ischemic postconditioning, which were proven to be effective against the apoptotic process. Spinal cord ischemia was produced in rats using an intrathoracic approach to implement the synchronous arcus aorta and subclavian artery clipping method. In our study, 42 male Sprague-Dawley rats (309 +/- 27 g) were used. Animals were divided into sham operated, spinal ischemia, citicoline, postconditioning, and postconditioning citicoline groups. Postconditioning was generated by six cycles of 1 min occlusion/5 min reperfusion. A 600 mmol/kg dose of citicoline was given intraperitoneally before ischemia in the citicoline and postconditioning citicoline groups. All rats were sacrificed 96 h after reperfusion. For immunohistochemical analysis, bcl-2, caspase 3, caspase 9, and bax immune staining were performed. Caspase 3, caspase 9, bax, and bcl-2 were used as apoptotic and antiapoptotic markers, respectively. The blood pressure values obtained at the onset of reperfusion were significantly lower than the preischemic values. A difference in immunohistochemical scoring was detected between the caspase 3, caspase 9, bax, and bcl-2 groups. When comparisons between the ischemia (groups 2, 3, 4, and 5) and sham groups (group 1) were performed, a significant increase in caspase 3, caspase 9, bax, and bcl-2 was detected. When comparing the subgroups, the average score of caspase 9 was found to be significantly higher in ischemia group 2. The average score of bcl-2 was also found to be significantly higher in postconditioning and citicoline group 5. It is thus thought that combining citicoline with postconditioning provides protection by inhibiting the caspase pathway and by increasing the antiapoptotic proteins.
Clinical and radiologic analysis of 3-level anterior cervical discectomy and fusion with interbody cages without plate fixation
(Elsevier, 2008-02) Doǧan, Şeref; Türkkan, Alper; Kocaeli, Hasan; Korfali, Ender; Bekâr, Ahmet; Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahisi Anabilim Dalı.; AAI-6531-2021; 7102693077; 25029159600; 6603500567; 7004641343; 6603677218
Objectives: The primary objective of this Study was to analyze the clinical and radiologic outcomes of 3-level anterior cervical discectomy and fusion procedures performed using interbody cages without plate fixation, Methods: Twenty-two patients with radiculomyelopathy were retrospectively evaluated. Functional Outcome of patients with radiculopathy was assessed using Odom's criteria, and myelopathic patients were rated according to Nurick's classification. Radiographs were used for evaluation of the cervical lordosis, fusion, foraminal height, and implant position. Results: An excellent or good functional result was found in all of the patients with radiculopathy. In addition, Nurick grades improved from a mean of 2.4 before surgery to a mean of 1.2 at follow-up (P = 0.007). These effects were accompanied by a significant increase in height of the foramina after surgery (P = 0.006). However, there was no statistically significant difference between cervical lordosis before Surgery and at final follow-Lip. Fusion was observed in 17 (77.3%) of the patients, whereas the remaining 5 patients (22.7%) had asymptomatic pseudarthrosis. Of the 66 total cages implanted, subsidence was present in 31 (46.9%). The mean follow-up was 26.1 months. Conclusions: The use of interbody cages Without plate fixation for 3-level anterior cervical discectomy increases cervical lordosis, increases foraminal height, assists fusion, and is associated with good clinical outcomes.
Clinical importance of the basal cavernous sinuses and cavernous carotid arteries relative to the pituitary gland and macroadenomas: Quantitative analysis of the complete anatomy
(Elsevier Science, 2008-08) Yılmazlar, Selçuk; Kocaeli, Hasan; Eyigör, Özhan; Hakyemez, Bahattin; Korfali, Ender; Uludağ ÜniversitesiNöroşirürji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Histoloji ve Embriyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöroradyoloji Anabilim Dalı.; 0000-0002-3425-0740; 0000-0003-3633-7919; 0000-0003-3463-7483; AAI-2318-2021; AAH-5070-2021; ABE-5128-2020; 6603059483; 6603500567; 6603109907; 6602527239; 7004641343
Background: It is unusual to encounter hemorrhagic complications caused by arterial or venous damage during TSS. Problems with these structures can lead to permanent disability or death. Our aim was to quantitatively analyze anatomical and radiologic relationships among the BCS, the CCA, and the pituitary gland, as these structures are accessed during TSS. Methods: Forty-nine formaldehyde-fixed, sellar-parasellar tissue blocks from adult cadavers were used to simulate accessing the BCSs via TSS. In each specimen, size of the pituitary gland and specific characteristics of each BCS and the horizontal segment of each CCA were recorded. Nine other specimens were used for histologic investigation and microanatomical measurements. To attest correlation between clinical data and cadaveric measurements, coronal MRI scans of 22 healthy adults as well as of 28 patients with macroadenomas were analyzed. Results: In cadaveric specimens, distances between both CCAs in the BCS were 17.1 +/- 4.0 mm anteriorly, 20.3 +/- 4.2 mm medially, and 18.8 +/- 4.6 mm posteriorly. In this study, the anterior medial space of the BCS was dominant in 12 specimens on the right side and in 5 specimens on the left; the posterior medial space of the BCS was dominant in 23 specimens on the right side and in 9 specimens on the left side. The right medial BCS was dominant in 35 specimens. On histologic coronal sections, some part of the carotid artery's (CA's) diameter was located below the line passing from the basal dural layer ranging from 5.3% to 65.4%. In normal-sella images, distances between both CCAs were 15.4 +/- 1.8 mm anteriorly, 16.0 +/- 2.8 mm medially, 16.2 +/- 3.4 mm posteriorly. On coronal normal-sella images, some part of the CA's diameter was located below the line passing from the basal dural layer ranging from 16.4% to 66.7%. In macroadenomas, distances between both CCAs were 22.0 +/- 3.6 mm anteriorly, 21.5 +/- 3.8 mm medially, and 20.7.2 +/- 3.7 mm posteriorly. On coronal images, in only 6 of 28 macroadenomas, some part of the CA's diameter was located below the line passing from the basal dural layer ranging from 12.5% to 100%. Conclusions: Our results indicate that a working area of 15.0 +/- 2.6 x 10.3 +/- 2.1 mm is safe during TSS. The position of the CCA posterior segment was notably more caudal than the anterior segment with respect to the basal dura, which should be taken into account during extended exposure. Also, preoperative recognition of the anatomical variations is beneficial for detection of the boundaries of dissection, which is particularly important in the BCS, where variable course of CCAs may transform the anatomical configuration. Slowly growing pituitary adenomas stretch out both CCAs considerably from medial to lateral directions, and they cause widening of intercarotid distances in all segments. Processing of fixation, decalcification, and paraffin embedding for the cadaveric tissue in contrast to physiologically hydrated tissues may change the accuracy of measurements. These measurements are significantly different than those in the radiologic images when arterial blood under pressure is in the CCA as well as when venous blood fills the cavernous sinus as is the case in vivo. In clinical practice, these facts must be taken into consideration in the cadaveric measurements.
Effect of craniotomy without shaving on patient mood
(Journal Neurological Sciences, 2013) Taşkapılıoğlu, Mevlüt Özgür; Eser, Pınar Ocak; Tunalı, Neslihan Zor; Korfali, Ender; Bekâr, Ahmet; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; 0000-0001-5472-9065; AAI-2073-2021; AAW-5254-2020; ABB-8161-2020; 25936798300; 55211742300; 55775646100; 7004641343; 6603677218
Background: Shaving before cranial surgery has been a common practice for many decades. Most of the studies were about the infection rates, but there is a few data about the effect of shaving on patient mood. The aim of this study was to determine the effects of not shaving when performing a craniotomy on the mood of the patients. Methods: Patients who underwent a craniotomy between September 2010 and September 2011 and agreed to complete a questionnaire after the surgery were included in the study. Results: 207 patients included in the study. The mean age of the patients was 44.51 +/- 18.00 years. 114 patients (55.07%) did not think about shaving when they first learned they would undergo a craniotomy; 133 (64.2%) did not ask their surgeons about being shaved during the craniotomy. 30 patients (14.4%) pointed out that not being shaved was an important factor in choosing the surgeon. Nineteen (9.1%) patients complained about the wide scar tissue and alopecia. Conclusion: Not shaving is a strong factor that affects the time necessary to get back to one's routine and orientation to social life after craniotomy without increasing infection rates. However, it is not a factor that affects the patient's choice of doctors.
Effects of citicoline used alone and in combination with mild hypothermia on apoptosis induced by focal cerebral ischemia in rats
(Elsevier, 2010-02) Türeyen, Kudret; Şahin, Soner; Alkan, Tülin; Temel, Şehime Gülsün; Tolunay, Şahsine; Korfali, Ender; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Fizyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Genetik Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Patoloji Anabilim Dalı.; AAH-2892-2021; AAH-1792-2021; AAG-8385-2021; 8272141000; 6601953747; 6507885442; 6602604390; 7004641343
The effects of citicoline used either alone or in combination with hypothermia on the suppression of apoptotic processes after transient focal cerebral ischemia were investigated. Middle cerebral artery occlusion (MCAo) was performed for 2 hours on Sprague-Dawley (SD) rats using intraluminal thread insertion. The treatment groups were as follows: Group 1, sham-operate 1; Group 2, saline; Group 3, citicoline (400 mg/kg intraperitoneal.); Group 4, hypothermia (34 +/- 1 degrees C); Group 5, citicoline + hypothermia. All rats were reperfused for 24 hours, and after sacrifice and transcardiac perfusion, immunohistochemical (mean standard deviation, 0.71 +/- 0.75) was lower compared to Groups 3, 4 and 5 (2.33 +/- 0.81; 3.00 +/- 0.00; 2.20 +/- 0.83; p < 0.05). There was higher expression of cispase-3 proteins in Group 2 (2.28 +/- 0.95) compared to Group 5 (1.50 +/- 0.83; p < 0.05). Bax proteins were also increased in Group 2 (1.85 +/- 1.06) compared to Group 5 (0.40 +/- 0.54) and in Group 4 (2.00 +/- 0.00) compared to Group 5 (0.40 +/- 0.54; p < 0.05). Significant differences in caspase-9 immunostaining scores were found in Group 2 (2.29 +/- 0.96) compared to Group 5 (0.20 +/- 0.44) (p < 0.05); Group 3 (1.00 +/- 0.70) compared to Group 5 (0.20 +/- 0.44: p, < 0.05); and Group 4 (3.00 +/- 0.00; p < 0.05) compared to Group 5 (0.40 +/- 0.54; p < 0.05). Thus by suppressing apoptotic processes citicoline with hypothermia is more effective than ;either used alone in ameliorating cerebral damage after transient focal ischemia.
Endovascular treatment of ruptured aneurysm associated with vertebrobasilar junction fenestration: Case report
(Ortadoğu Yayınları, 2010-04) Hakyemez, Bahattin; Erdoğan, Cüneyt; Gökalp, Gökhan; Korfali, Ender; Parlak, Müfit; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; 0000-0002-3425-0740; AAI-2336-2021; AAI-2318-2021; 6602527239; 8293835700; 8312505100; 7004641343; 7003589220
Vertebrobasilar junction fenestration is a rare congenital anomaly which is commonly seen with an aneurysm formation. Because of the complex anatomical structure of this area complicates the surgical intervention, endovascular coil treatment of aneurysm is an alternative method. Several fenestration-related aneurysms may not be detected by 2D conventional angiography imaging due to their considerably thin and short structure or small size. By 3D rotational digital subtraction angiography, small-sized fenestrations can be examined at the intended plane from various angles. This method enables us to plan the endovascular intervention in detail by revealing orientation, neck, origin of perforator arteries, and the relation between aneurysm and fenestration. In the present case, we present the angiographic results of the case with vertebrobasilar junction fenestration, along with endovascular treatment of the ruptured aneurysm.
MK-801 improves neurological and histological outcomes after spinal cord ischemia induced by transient aortic cross-clipping in rats
(Elsevier Science, 2005) Kocaeli, Hasan; Korfali, Ender; Öztürk, Hülya; Kahveci, Nevzat; Yılmazlar, Selçuk; Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; 0000-0003-3633-7919; 0000-0003-0841-8201; AAH-5070-2021; AAG-7070-2021
Background: Glutamergic excitotoxicity has been shown to play a deleterious role in the pathophysiology of ischemic spinal cord injury (ISCI). The aim of this study was to investigate the neuroprotective effect of a single dose of MK-801, an antiexcitotoxic drug, in a rat model of ISCI. Methods: Ischemic spinal cord injury was induced for 17 minutes in Sprague-Dawley rats using direct aortic arch, just proximal to the left common carotid artery, plus left subclavian artery cross-clamping through a left-sided limited thoracotomy. Study groups were as follows: control group (n = 8) receiving only vehicle and experimental group (n = 8) receiving a single dose of MK-801 (1 mg/kg IV) 10 minutes before aortic clamping. Neurological examination was performed at 6 hours, 24 hours, and daily up to 96 hours. Rats were sacrificed at 96 hours, and spinal cords were removed for histopathology. Results: All the control rats had severe permanent neurological deficits after ISCI, whereas the MK-801-treated rats had statistically (P <.05) better neurological outcome and good recovery. Histopathology revealed severe neuronal necrosis in the lumbar gray matter of control rats, whereas MK-801-treated rats showed mild injury. Conclusion: These results demonstrate that combined temporary clipping of the aortic arch (just proximal to the left common carotid artery) plus left subclavian artery for 17 minutes reproduces reliable paraplegia, and a single dose of MK-801 given before ISCI provides significant neuroprotection.
Results of anterior transcallosal approach to pediatric colloid cysts
(Galenos Yayincilik, 2011-04-01) Taskapılıoğlu, Mevlüt Özgür; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; Kuytu, Turgut; Kaplan, Tolga; Korfali, Ender; Kocaeli, Hasan; KOCAELİ, HASAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; 0000-0001-5472-9065; ABB-8161-2020; AAW-5254-2020; CAI-2032-2022
Introduction: Colloid cysts represent 0.5-1% of all intracranial neoplasms and 55% of the third ventricular lesions. In this study, we emphasized the principles of treatment in pediatric cases with third venricular colloid cysts treated by using anterior interhemispheric transcallosal approach.Materials and Method: The patients aged 16 years and below with colloid cysts, operated between 2001-2009, were evaluated retrospectively.Results: There were 3 males and 1 female patients aged between 12-16 (mean age 13.75) years. The mean duration of symptoms were 2.5 months and mean duration of follow-up 46.75 (15-102) months. All the patients had frontal headache as a main complaint; 2 patients also had nausea and vomiting; and 1 patient also had numbness on the left side of his body. Three patients had bilateral marked papil edema while 1 patient had no neurological deficit. Cyst was hyperintense and hypointense in cranial computed tomography of 2 and 1 patients, respectively. T1-, and T2-weighted cranial magnetic resonance images were iso-, and hyperintense in 2 patients while hypo-, and hyperintense in 1 patient, while hyper-, and isointense in 1 patient respectively. Interhemispheric-transcallosal-transforaminal approach was used in all patients. In 3 patients, total excision was performed while in 1 patient, a small part of capsule attached to thalamostriate vein was left. There were no cyst recurrences at follow-up.Conclusions: Although various approaches had been described to reach the third ventricular colloid cyst; we preferred the transcallosal approach in all of our pediatric patients since the approach does not cause any cortical breach and provides secure tumour resection.
Surgical limits in transnasal approach to opticocarotid region and planum sphenoidale: An anatomic cadaveric study
(Elsevier Science, 2010-04) Özcan, Tekin; Yılmazlar, Selçuk; Aker, Sibel; Korfali, Ender; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Patoloji Anabilim Dalı.; 0000-0003-3633-7919; AAH-5070-2021; 25636374000; 6603059483; 12795285000; 7004641343
BACKGROUND: The significance of medial and lateral opticocarotid recesses and the planum sphenoidale region in skull base pathologies for the transsphenoidal-transplanum approach were evaluated. METHODS: The sphenoid bone block samples were extracted from adult cadavers. Dissections and measurements in the opticocarotid and planum sphenoidale regions were performed in 29 samples using a surgical microscope. For histologic evaluation, oblique sections through the bilateral opticocarotid regions were obtained and examined in eight samples. RESULTS: Optic, carotid prominences, and medial and lateral opticocarotid recesses can be identified as lateral markers intraoperatively to the extent of the exposure. The lateral opticocarotid recess was observed to be prominent in all samples. In all samples, the groove formed by optic and carotid prominences between the medial and lateral opticocarotid recesses was seen. This groove was designated the inter-recess sulcus. In the transsphenoidal-transplanum approach, the area needed for a reliable bone resection was measured as a mean of 237.32 +/- 30.96 mm(2). The mean angle between optic nerves was 115.41 +/- 18.39 degrees. The mean anteroposterior length of the planum sphenoidale was 14.84 +/- 1.52 mm. In histologic sections, collagenous ligaments between the anterior part of cavernous sinus and the adventitia layer of internal carotid artery were more frequent and regular than the inferior part of optic nerve. CONCLUSIONS: The lateral opticocarotid recess is a reliable and persistent indicator for extended transsphenoidal surgery. To approach the opticocarotid region near the internal carotid artery and optic nerve, a careful dissection is needed to minimize surgical injuries to the optic nerve and carotid artery. Other factors determining a reliable bone resection are the anteroposterior length of the planum sphenoidale and the distance and width of the angle between optic nerves. Attention should be given to individual anatomic variations of the region when planning and performing transsphenoidal-transplanum surgery.