Biomedical subjects

Tuncalp Ozgen

Publications and source records attributed to Tuncalp Ozgen.

11 recordsLinked to original sources

PubMed2006

Distal anterior choroidal artery aneurysms.

BACKGROUND: Distal AChoA aneurysms are quite rare. Only 12 operated cases have been reported in the English medical literature. Treatment of these aneurysms is also difficult because of their deep location, small size, and angioarchitecture. METHODS: The authors report 2 additional patients with aneurysms, arising from the distal AChoA and located within the temporal horn of the lateral ventricle. In the first patient, the aneurysm could also be visualized with CTA, which is the first demonstration in the literature. RESULTS: The aneurysms were explored and resected via a transtemporal/ventricular approach in both patients. One patient was discharged as neurologically intact and the other died because of severe vasospasm. CONCLUSIONS: The conclusions drawn from our experience and a comprehensive review of the literature include the following: (1) A distal AChoA aneurysm should be considered in patients with isolated medial temporal intracerebral hematoma with intraventricular extension. (2) These aneurysms are frequently very small (<5 mm). Therefore, they cannot be detected on initial angiograms in some cases. (3) These small aneurysms cannot be usually clipped without sacrificing the parent artery. (4) Sacrificing distal AChoA (beyond the plexal point) does not usually cause any neurological deficit, but, whenever possible, this artery should be preserved.

Adult↗

PubMed2006

Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience.

We present the long-term clinical and angiographic follow-up results of 100 consecutive intracranial aneurysms treated with Onyx liquid embolic system (MTI, Irvine, Calif.), either alone or combined with an adjunctive stent, in a single center. A total of 100 aneurysms in 94 patients were treated with endosaccular Onyx packing. Intracranial stenting was used adjunctively in 25 aneurysms including 19 during initial treatment and 6 during retreatment. All aneurysms except two were located in the internal carotid artery. Of the 100 aneurysms, 35 were giant or large/wide-necked, and 65 were small. Follow-up angiography was performed in all 91 surviving patients (96 aneurysms) at 3 and/or 6 months. Follow-up angiography was performed at 1, 2, 3, 4 and 5 years in 90, 41, 26, 6 and 2 patients, respectively. Overall, aneurysm recanalization was observed in 12 of 96 aneurysms with follow-up angiography (12.5%). All 12 were large or giant aneurysms, resulting in a 36% recanalization rate in the large and giant aneurysm group. One aneurysm out of 25 treated with the combination of a stent and Onyx showed recanalization. There was also no recanalization in the follow-up of small internal carotid artery aneurysms treated with balloon assistance only. At final follow-up, procedure- or device-related permanent neurological morbidity was present in eight patients (8.3%). There were two procedure-related and one disease-related (subarachnoid hemorrhage) deaths (mortality 3.2%). Delayed spontaneous asymptomatic occlusion of the parent vessel occurred in two patients, detected on routine follow-up. Onyx provides durable aneurysm occlusion with parent artery reconstruction resulting in perfectly stable 1-year to 5-year follow-up angiography both in small aneurysms treated with balloon assistance only (0% recanalization rate) and large or giant aneurysms treated with stent and Onyx combination (4% recanalization rate). Endosaccular Onyx packing with balloon assistance may not be adequate for stable long-term results in those with a large or giant aneurysm. However, the recanalization rate of 36% in these aneurysms is better than the reported results with other techniques, i.e., coils with or without adjunctive bare stents.

Adolescent↗

PubMed2006

Comparative dural closure techniques: a safety study in rats.

BACKGROUND: Some neurosurgical procedures have high morbidity and mortality rates due to cerebrospinal fluid (CSF) fistula development, particularly when dural defects are in relatively inaccessible areas or surrounded by friable dura. We used a rat model to test 4 different dural closure techniques to determine which one was significantly superior for achieving a watertight dural closure with minimal harm to brain tissue. METHODS: The rats were randomly divided into 2 groups. The first group (group A, n = 40) was used to test the strength of the adhesivity for CSF leakage. Histopathologic studies were used to evaluate the granulation tissue between the dura and dural graft. Effects on the brain tissue were studied in the second group (group B, n = 40) where lipid peroxidation was determined. These 2 groups consisted of 5 subgroups: control, methyl metacrylate, n-butyl cyanoacrylate, fibrin glue, and CO(2) laser. RESULTS: Methyl metacrylate and CO(2) laser techniques were inadequate for stopping dural leakage and had harmful effects on brain tissue. Cerebrospinal fluid leak was observed only in 1 rat in the n-butyl cyanoacrylate subgroup and this result was statistically significant (P = .0005), but lipid peroxidation levels for this material showed that it was not safe for dural closure in case it leaked through the dural defect. The lipid peroxidation levels of the fibrin glue subgroup were not statistically significantly different from the control group (P = .440). CONCLUSIONS: Fibrin glue was the safest material with a CSF leakage risk that was higher than n-butyl cyanoacrylate (25% vs 12.5%) but acceptable. This study showed no relationship between the CSF leak and histopathologic findings for sealant properties of the tissue adhesives.

Animals↗

PubMed2006

Unrecognized intracerebral glass particle mimicking cavernoma: case report.

OBJECTIVE AND IMPORTANCE: Although the presence of a foreign body in the cranium after a head injury is a well-known entity, cases of retained intracranial foreign bodies causing a delayed onset of neurological symptoms are rare. To our knowledge, an unrecognized intracerebral glass particle mimicking a cavernoma has not been previously reported in the literature. CLINICAL PRESENTATION: We report a unique case regarding an intracranial foreign body. A 39-year-old patient presented with new-onset epilepsy. The patient had no history of trauma. According to the magnetic resonance imaging findings and the patient's clinical course, the responsible lesion was considered to be a temporal cavernoma. INTERVENTION: During the operation, surprisingly, a glass particle was found within the temporal lobe. The glass had penetrated the cranium during a minor head injury and had remained undetected for 33 years. The patient was seizure-free without medication during 3 years of follow-up. CONCLUSION: Intracranial small foreign bodies can be difficult to diagnose, especially in patients with no history or a vague history of head trauma. Patients with long-standing retained foreign bodies may remain clinically well until complications arise. Intracranial foreign bodies may mimic other pathologies clinically and radiologically.

Adult↗

PubMed2005

Multiple aneurysms of the anterior communicating artery: radiological and surgical difficulties.

OBJECT: Multiple aneurysms of the anterior communicating artery (ACoA) occur rarely and have not been well investigated previously. The authors report on a consecutive series of six patients who each harbored multiple ACoA aneurysms. The radiological and surgical difficulties encountered in treating these complex and uncommon aneurysms are described and the pertinent literature is reviewed. METHODS: Between October 1996 and August 2003, the authors surgically treated 146 patients with ACoA aneurysms. Six (4.1%) of these patients harbored multiple aneurysms of the ACoA. Four of these patients were men and two were women; their ages ranged from 36 to 72 years. Five patients had two aneurysms and one patient had three. All underwent surgery performed using the pterional approach. The clinical presentations, angiograms, intraoperative difficulties, and surgical results were retrospectively analyzed. All patients had premorbid hypertension. In two cases, the aneurysms were initially misdiagnosed as a single complex aneurysm based on routine cerebral angiograms, but special angiographic views demonstrated double aneurysms. In one case, multiple ACoA aneurysms could be identified using three-dimensional (3D) computerized tomography (CT) angiography. The size of the ACoA aneurysms ranged from 3 to 12 mm (mean 5.3 mm). A total of 13 ACoA aneurysms were successfully occluded in the six patients. Four patients were discharged in good condition, and two patients died. CONCLUSIONS: Although multiple ACoA aneurysms are quite rare, the following points should be kept in mind. (1) In bilobular ACoA aneurysms, special angiographic projections and 3D CT angiography or 3D digital subtraction angiography should also be performed to obtain a correct diagnosis. The differentiation of two aneurysms from a bilobular aneurysm during the preoperative period is important for surgical planning. (2) Angiographically, detection of the ruptured aneurysm is often difficult. (3) Resection of the gyrus rectus is necessary to obtain a good operative exposure. 4) Clip selection and sequencing are important. Straight clips with short blades should be preferred to avoid narrowing of the surgeon's view and a collision between the clips.

Adult↗

PubMed2005

Rare cause of subarachnoid hemorrhage: spinal meningeal carcinomatosis. Case report.

Subarachnoid hemorrhage (SAH) of spinal origin is a rare entity accounting for approximately 1% of all cases of SAH. Its most frequent causes are trauma and vascular malformations. Although primary spinal tumors, especially ependymomas, are also relatively common causes, SAH secondary to a metastatic spinal tumor arising from outside the central nervous system is an extremely rare condition; only one case has been reported in the literature. The authors present a case of spinal meningeal carcinomatosis secondary to cutaneous malignant melanoma in which the patient presented with only symptoms of SAH. Although very rare, this case underscores several factors. 1) Spinal SAH due to spinal metastases should be considered in the differential diagnosis of patients with previously known malignancy. 2) Spinal SAH may manifest without paraparesis or sensory deficit. 3) Magnetic resonance imaging of the spinal cord may be important to determine the source of SAH in patients in whom four-vessel cerebral angiography demonstrates no abnormal findings.

Adult↗

PubMed2004

Intracavernous granular cell tumor.

BACKGROUND: Granular cell tumors in the central nervous system are quite rare. To date, only 6 cases of granular cell tumor arising from cranial nerves have been reported in the literature. To the best of our knowledge, we present the first case of a predominant intracavernous granular-cell tumor arising from oculomotor nerve. CASE PRESENTATION: A 42-year-old man presented with third-nerve paresis and decreased visual acuity on the left side. Magnetic resonance imaging showed a mainly intracavernous mass partially extending to the superior orbital fissure and entrance of the optic canal. Using a pterional craniotomy, the tumor was removed from within the cavernous sinus via combined superior and lateral intradural approach, and optic nerve was also decompressed. Histologically, the tumor was diagnosed as a granular cell tumor. CONCLUSIONS: Although it is quite rare, granular cell tumor should be included into the differential diagnosis of intracavernous masses because surgical treatment is curative.

Adult↗

PubMed2004

Acute parotitis following sitting position neurosurgical procedures: review of five cases.

Acute bacterial parotitis subsequent to major abdominal surgery is well documented, reportedly occurring in as many as 0.1% of patients. Postoperative parotitis has been reported between 1 to 15 weeks after surgery, commonly appearing within 2 weeks of the procedure. However, postoperative parotitis has not been reported previously after neurosurgical procedures. The authors report five cases of postoperative parotitis after neurosurgical operations in the sitting position with mild flexion and rotation of the head. This group of patients accounted for 0.16% of all craniotomy and 1.9% of all sitting position neurosurgical procedures performed in the authors' institution from 1996 through 2001. Neck flexion and head tilt in the sitting position might have an influence on acute parotitis. The authors found that the side of the parotitis was on the opposite side of the head rotation. Dehydration therapy may also be a contributing factor. The objective of this paper is to state that parotitis is a possible complication in neurosurgical patients operated on in sitting position and to discuss its pathophysiology and treatment options.

Acute Disease↗

PubMed2003

Spinal dural arteriovenous fistula and venous aneurysm: an unusual association.

OBJECTIVE: Although spinal intradural arteriovenous malformations have frequently been associated with venous aneurysms, spinal dural arteriovenous fistulas typically are not. We describe a case of conus medullaris compression by a large saccular venous aneurysm of a spinal dural arteriovenous fistula. As these lesions are slow-flow arteriovenous shunts, development of a venous aneurysm is an unexpected condition. Pathogenesis of these aneurysms is briefly discussed. METHODS: A 61-year-old man presented with progressive spastic paraparesis of 1-year duration. Spinal magnetic resonance (MR) suggested abnormal serpiginous vessels and a partially thrombosed aneurysm at the level of conus medullaris. Spinal angiography was performed but some lower thoracal and upper lumbar segments could not be catheterized because of severe atherosclerosis. As a result, vascular anomaly could not be demonstrated angiographically, but surgical exploration was found to be necessary because of positive clinical and MR findings. RESULTS: An arteriovenous fistula that entered the spinal canal beneath the L1 pedicle on the left was identified. It was easily coagulated and cut. The partially thrombosed aneurysm within the conus medullaris was also resected. CONCLUSIONS: Our case illustrates two important points related to patients harboring spinal dural arteriovenous fistulas (AVF): First, clinical suspicion and MR findings are important in diagnosis of these lesions and surgical exploration is indicated despite negative or nondiagnostic angiographic results in such cases. Second, venous aneurysms may be associated with spinal dural AVFs, and although spinal dural AVFs are low-flow lesions, the development of the venous aneurysm is probably a result of high venous pressure.

Aneurysm↗

PubMed2003

Locked-in syndrome due to metastatic pontomedullary tumor--case report.

A 21-year-old man presented with an extremely rare case of locked-in syndrome caused by a metastatic brainstem tumor manifesting as quadriplegia, lower cranial nerve pareses, and irregular respiration. Cranial magnetic resonance imaging revealed a large pontomedullary tumor. An emergency operation was performed via a posterior fossa approach and the tumor was grossly totally removed. The histological diagnosis was malignant melanoma. The clinical status of the patient remained unchanged and he died on postoperative day 34 of diffuse bronchopneumonia. Locked-in syndrome is characterized by quadriplegia, lower cranial nerve paralysis, and mutism but with maintenance of consciousness, as well as vertical eye movements and eyelid blinking. This case suggests that locked-in syndrome should be considered in any patient seemingly comatose or stuporous, this syndrome may be due to a pontomedullary tumor, and malignant melanoma metastasis should be considered in the differential diagnosis of patients who present with brainstem tumor.

Adult↗

PubMedDate not supplied

Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results.

BACKGROUND AND PURPOSE: We present our preliminary experience, including mid-term angiographic and clinical follow-up results, with an alternative technique for the endovascular treatment of intracranial aneurysms in a series of patients. This new method, previously described in anecdotal case reports, consists of endovascular deployment of an artificial vessel graft (stent graft or covered stent) in the parent vessel to exclude the intracranial aneurysm sac from circulation. METHODS: Twenty-five internal carotid artery (ICA) aneurysms in 24 patients were successfully treated by using a Jostent coronary stent graft deployed in the parent artery across the aneurysm neck. All except four aneurysms were extradural, located in the petrous or cavernous portion of the ICA. The four intradural aneurysms were located in the carotico-ophthalmic region. Seventeen aneurysms in 16 patients occurred posttraumatically, secondary to motor vehicle accidents or surgical injury. RESULTS: Twenty-three aneurysms were immediately excluded from circulation after stent graft placement. In two aneurysms, a slow contrast material filling (endoleak) into the aneurysm cavity was observed immediately after treatment. One was thrombosed, as shown by late control angiography; in the other one, a second larger bare stent was used to appose the stent graft's distal end to the ICA wall, thus sealing the endoleak into the distal graft. No technical adverse event, including vessel dissection, vessel perforation, or thromboembolism, occurred with or without clinical consequence. No mortality or morbidity developed during or after the procedure, including the follow-up period. Two-year control angiography in one patient, 1.5-year control angiography in two patients, 1-year control angiography in six patients, and 6-month control angiography in 12 patients were performed, revealing reconstruction of the ICA with no aneurysm recanalization. All symptoms resolved after treatment in the patients who had initially presented with mass effect. CONCLUSION: Initial anatomic, clinical and mid-term follow-up results in this small series of patients are encouraging. This technique has been proved to have potential in the reconstructive treatment of intracranial aneurysms. Further research and development are needed to optimize the stent graft technology for the cerebrovascular system.

Adolescent↗