PubMed

Permanent URI for this collectionhttps://hdl.handle.net/11452/24864

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Anatomical study of the cavernous sinus emphasizing operative approaches
(Türk Nöroşirürji Derneği, 2010-04) Boyacı, Suat; Aksoy, Kaya; Dalgıç, Adem; Tıp Fakültesi; Beyin ve Sinir Cerrahisi Ana Bilim Dalı; 36135211700
AIM: The aim of this article is to describe the microsurgical anatomy of the cavernous sinus, the triangles, and the osseous relationships in the region with special attention to the relationships important in surgical approaches on the intracavernous structures. MATERIAL and METHODS: Fifty cavernous sinuses obtained from twenty-five cadaver heads were studied in detail using magnification. Stepwise dissections of the cavernous sinuses performed to demonstrate the intradural and extradural routes, anatomy of the triangles and osseous relationships in the region. RESULTS: The main branches of the intracavernous portion of the carotid artery were the meningohypophyseal, the inferior cavernous sinus, and McConnell's capsular artery. The main branches of the meningohypophyseal trunk were the tentorial, the dorsal meningeal, and the inferior hypophyseal artery. There were variations of the main branches of the meningohypophyseal trunk. The sixth cranial may splite into rootlets as it passes lateral to the carotid artery. There were size and shape variation of the triangles. CONCLUSION: A precise understanding of the bony relationships, the anatomy of the triangels and neurovascular content of the cavernous sinus, together with the use of cranial base and microsurgical techniques are necessary for safer surgery. A single approach is not capable of providing exposure of all parts of the sinus.
Bilateral high-level percutaneous cervical cordotomy in cancer pain due to lung cancer: A case report
(Elsevier Science, 2006-07-11) Bekar, Ahmet; Kocaeli, Hasan; Abaş, Faruk; Bozkurt, Merlin; Tıp Fakültesi; Beyin ve Sinir Cerrahisi Ana Bilim Dalı; 6603677218; 6603500567; 8546184300; 16202046200
Background: Computed tomography–guided high-level percutaneous cordotomy has been used unilaterally or bilaterally for the treatment of localized intractable pain in malignancies. Case Description: A 57-year-old man was admitted to the hospital with the complaint of intractable pain involving the left side of the chest, axillary region, and shoulder. He was operated for small cell lung cancer on the left side in December 2003 and received radiotherapy and chemotherapy. His neurological examination was normal. Magnetic resonance imaging of the thorax revealed contrast- enhancing lesions on the left side extending to mediastinum and pleura. His pain was relieved completely after the first cordotomy procedure, and he was discharged from the hospital on the second postoperative day. The patient was readmitted to the hospital with the complaint of severe unilateral chest pain like the initial pain on the right side 4 days after cordotomy. The CT-guided bilateral high-level percutaneous cordotomy was performed with a 15-day interval. Conclusion: The CT-guided bilateral high-level percutaneous cordotomy can be used in the treatment of intractable upper trunk pain in patients with cancer without pulmonary dysfunction.
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; Tıp Fakültesi; Beyin ve Sinir Cerrahisi Ana Bilim 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.
Effects of cross-linked high-molecular-weight hyaluronic acid on epidural fibrosis: Experimental study
(American Association of Neurological Surgeons, 2015-01) Işık, Semra; Taskapılıoğlu, M. Özgür; Atalay, Fatma Öz; Doğan, Şeref; Tıp Fakültesi; Beyin ve Sinir Cerrahisi Ana Bilim Dalı; 0000-0001-5472-9065; K-6580-2015; AAW-5254-2020; JHC-4482-2023; AAI-6531-2021; 55972140700; 25936798300; 15623010600; 7102693077
OBJECT: Epidural fibrosis is nonphysiological scar formation, usually at the site of neurosurgical access into the spinal canal, in the intimate vicinity of and around the origin of the radicular sheath. The formation of dense fibrous tissue causes lumbar and radicular pain. In addition to radicular symptoms, the formation of scar tissue may cause problems during reoperation. The authors aimed to investigate the effects of cross-linked high-molecular-weight hyaluronic acid (HA), an HA derivative known as HA gel, on the prevention of epidural fibrosis by using histopathological and biochemical parameters. METHODS: Fifty-six adult female Sprague-Dawley rats were evaluated. The rats were divided into 4 groups. Rats in the sham group (n = 14) underwent laminectomy and discectomy and received no treatment; rats in the control group (n = 14) underwent laminectomy and discectomy and received 0.9% NaCl treatment in the surgical area; rats in the HA group (n = 14) received HA treatment at the surgical area after laminectomy and discectomy; and rats in the HA gel group (n = 14) underwent laminectomy and discectomy in addition to receiving treatment with cross-linked high-molecular-weight HA in the surgical area. All rats were decapitated after 4 weeks, and the specimens were evaluated histopathologically and biochemically. The results were statistically compared using the Mann-Whitney U-test. RESULTS: Compared with the sham and control groups, the HA and HA gel groups showed significantly lower fibroblast cell density and tissue hydroxyproline concentrations (p < 0.05). There was statistically significant lower dural adhesion and foreign-body reaction between the control and HA gel groups (p < 0.05). Granulation tissue and epidural fibrosis were significantly lower in the HA and HA gel groups compared with the sham group (p < 0.05). There were no significant differences in any histopathological parameters or biochemical values between Groups 3 and 4 (p > 0.05). CONCLUSIONS: Cross-linked high-molecular-weight HA had positive effects on the prevention of epidural fibrosis and the reduction of fibrotic tissue density. The efficacy of this agent should also be verified in further experimental and clinical studies.
Intraperitoneal administration of CDP-choline or a combination of cytidine plus choline improves nerve regeneration and functional recovery in a rat model of sciatic nerve injury
(Taylor & Francis, 2012-04) Caner, Başak; Ulus, İsmail H.; Kafa, Mustafa İlker; Bekar, Ahmet; Kurt, Mustafa Ayberk; Karlı, Necdet; Cansev, Mehmet; Tıp Fakültesi; Beyin ve Sinir Cerrahisi Ana Bilim Dalı; 0000-0003-3368-8123; AAR-4341-2020; M-9071-2019; AAG-7125-2021; 8786511500; 6603677218; 35603735000; 6506587942; 8872816100
Objective: Topical cytidine-5'-diphosphocholine (CDP-choline) improves functional recovery and promotes nerve regeneration in sciatic nerve injury in rats. The aims of this study were to test whether systemic treatment with CDP-choline was effective in improving the recovery of injured sciatic nerve, and to determine whether the cytidine and/or choline moieties of CDP-choline contribute to its beneficial actions. Methods: Seventy Sprague-Dawley rats underwent a surgical procedure that involved transectioning and immediate surgical repairing of the right sciatic nerve. Rats were assigned to one of five groups and administered intraperitoneally 1 ml/kg of saline ( control) or saline containing 600 mmol/kg of each of CDPcholine, cytidine, choline, or cytidine + choline. Results: Recovery in sciatic function index score was greater in rats treated with CDP-choline, choline, or cytidine + choline at 8 and 12 weeks after the interventions. Peripheral nerve regeneration evaluated by electromyography at 12 weeks was also greater in rats receiving CDP-choline ( 228% of control), choline ( 168% of control), or cytidine + choline ( 221% of control). Axon counts and axon density increased significantly following CDP-choline, choline, or cytidine + choline, respectively. Treatment with equivalent dose of cytidine failed to affect sciatic function index, electromyography, and axon counts. Treatment with CDP-choline, but not its metabolites improved nerve adherence and separability score. Conclusion: These data show that intraperitoneal CDP-choline, as well as the combination of its metabolites, cytidine + choline, improves functional recovery and promotes regeneration of injured sciatic nerves in rats. CDP-choline also improves nerve adherence and separability.

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