Biomedical subjects
Publications and source records attributed to E Timurkaynak.
A case of a tail in a 9-month-old baby is reported. Computed tomography and magnetic resonance imaging clearly demonstrated the presence of spina bifida and lipoma continuous from the tail to the spinal canal. A few medical-historical aspects are discussed. The human tail may be related to spinal dysraphism and requires detailed neuroimaging investigation and microsurgery.
Simple pneumocephalus most frequently arises as a complication of a head injury in which a compound basal skull fracture with tearing of the meninges allows entry of air into the cranial cavity. It can also follow a neurosurgical operation. Tension traumatic pneumocephalus with intraventricular extension is an extremely rare, potentially lethal condition that requires prompt diagnosis and treatment. We report the case of subdural and intraventricular accidental tension pneumocephalus occurring in a 26-year-old man as a result of skull fracture. This case is combined with rhinorrhea and meningitis that suggest some difficulties to treat. The operative procedure associated with medical treatment was performed and a good result was obtained.
An 18-year-old female patient was hospitalized with headache and disturbance of consciousness. Magnetic resonance imaging (MRI) revealed a tumor in the left parieto-occipital lobe. The tumor was totally removed, and postoperative radiation therapy was administered locally at 50 Gy. Ten months later, she experienced sudden onset of unconsciousness and headache. Computed tomography (CT) and MRI demonstrated multiple mass lesions in the whole brain. Following the systemic chemotherapy, removal of the largest tumor was performed. Histological examination proved all excised tumors to be oligodendroglioma without evidence of malignant change.
Using detailed cadaveric dissection this study has demonstrated the increase in exposure by using the inferolateral microsurgical approach for neurosurgical and ophthalmological access. The approach to surgical exploration of this region is divided into three steps. The neural, muscular and vascular structures of each step are discussed. We think that, with an intimate understanding of the anatomy of the orbit, many large intraorbital lesions located in the muscle cone and the inferior nasal compartment of the orbit can be safely removed through inferolateral orbitotomy.
We conducted a retrospective analysis of 22 patients having orbital penetrating gunshot wounds treated over a 4-years period. The neurological status and the site of injury for each patient are evaluated in this study. We propose a practical protocol in the management of these orbital foreign bodies. Surgical treatment was performed in 4 patients (had functional deficit) with medial orbitotomy in 2, lateral orbitotomy in 1, and superior orbitotomy in 1. 3 of them are improved, in one case the blindness has been continued. 18 patients were treated conservatively and all of them are improved. All patients were followed-up for 2 years with cranial X-rays and CT scans. Neurological sequelae were regressed which existed before the surgery. In conservatively treated cases, infection, migration and functional deficit were not seen. In conclusion, orbital penetrating gunshot wounds must be evaluated precisely by the surgeon and this evaluation sets the guidelines for management. The operation should be reserved for the patients in whom the necrotic soft tissues or orbital damages restrict ocular movements.
The authors have identified and described three lateral approaches to the intraorbital portion of the optic nerve in cadavers. The structures exposed via the superior, inferior or central approaches were directed through the lateral orbital wall. The superior approach in which the lateral rectus muscle is retracted inferiorly exposes the superolateral aspect of the orbit. The inferior approach in which the lateral rectus muscle is retracted superiorly, provided the inferolateral aspect of the optic nerve from the globe to the muscle cone. The central approach in which the lateral rectus muscle was disinserted and retracted provided excellent exposure of the structures of the lateral part of the orbit and the optic nerve. There were no structures blocking access to the ciliary ganglion and two third anterior optic nerve and lateral surface of the globe. The structures encountered in these approaches are demonstrated under magnification in cadavers, and the exposure of the optic nerve is discussed.
Cushing's disease resulting from intrasellar gangliocytomas is very rare and only three cases have been reported to date. All of the cases were female. We present a fourth case of Cushing's disease resulting from intrasellar gangliocytoma. Computed tomography and magnetic resonance imaging scans showed a pituitary macrotumor with suprasellar extension. A greenish-gray colored homogenous tumor was subtotally removed by a transcranial approach. Histological diagnosis was gangliocytoma. To the best of our knowledge, this is the first reported instance of a tumor causing Cushing's disease in a man in the absence of a pituitary adenoma component.
A case of a mesencephalic region cyst is reported. Neuroepithelial cysts are rare benign lesions that may be asymptomatic or may appear as space-occupying mass lesion. The pathogenesis and principles of diagnosis and management of these rare lesions are reviewed.
The anatomy needed to plan microoperative approaches to the lateral ventricles was examined in 20 cadaveric cerebral hemispheres. The neural, arterial, and venous structures in the walls of the lateral ventricles and the relationship of the lateral ventricles to the third ventricle and basal cisterns were examined. The operative approaches to the lateral ventricle are reviewed.
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In this report two unusual and serious neurological complications of dimeglumine iocarmate (Dimer X) myelography is presented. One patient became paraplegic six hours after myelography, and the other was mute for 24 hours after having generalised convulsions. The reasons are discussed.