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  • Küçük Resim
    Öğe
    Microsurgical fenestration and cystoperitoneal shunt through preauricular subtemporal keyhole craniotomy for the treatment of symptomatic middle fossa arachnoid cysts in children
    (Springer Verlag, 2015) Sılav, Gökalp; Sarı, Ramazan; Bölükbaşı, Fatih Han; Altaş, Murat; Işık, Nejat; Elmacı, İlhan
    The optimal surgical treatment for symptomatic middle fossa arachnoid cyst is still controversial. The most leading therapeutic options include cyst shunting and fenestration (endoscopic, microsurgical). We present our experience on surgical treatments of arachnoid cysts. A retrospective data review of 16 children who underwent keyhole craniotomy for microsurgical fenestration and shunting of middle fossa arachnoid cysts between 1999 and 2012 was performed after institutional review board approval. The average patient age was 6.1 years. The average follow-up period was 36.5 months. There were ten male and six female patients in the series. Indications for surgery included intractable headaches (50 %), increasing in cyst size (18.75 %), and seizures (31.25 %). All patient records were reviewed for their clinical presentation, classification, cyst resolution, symptom resolution, and cyst outcomes. After surgery, all patients underwent assessments of clinical and radiological improvement. Postoperative complications were observed in two cases: progressively resolving monoparesia in one case and resolving epileptic seizure with monotherapy in the other. All patients had a satisfactory clinical outcome, and in 87.5 %, there was either a decrease in the size or a complete disappearance of the MFAC. Nevertheless, three (18.75 %) of all patients needed shunt revision because of shunt dysfunction. Complication related to surgical technique was cerebrospinal fluid leak which spontaneously resolved in one patient. Microsurgical fenestration with keyhole craniotomy to provide passage between cysts to basal cisterns together with cystoperitoneal shunting during the same operation is still an effective and safe method in cases with symptomatic middle fossa arachnoid cysts in children.
  • Küçük Resim
    Öğe
    The expression of MMP-11 in benign meningiomas
    (Journal Neurological Sciences, 2014) Ayan, Erdo?an; Uyar, Süheyla Bozkurt; Çerçi, Ajlan; Altaş, Murat; Bölükbaşı, Fatih Han; Elmacı, İlhan; Sav, Aydın Murat
    The WHO categorises tumours based on their histological properties; however, this classification falls short of understanding their biological behaviours. Recently, there has been an increase in the number of studies on extracellular matrix components with the aim of understanding the biological behaviours of tumours. MMP-11 is a metalloproteinase from the MMP family that has a different expression pattern, mechanism of action, and substrate range compared with the other members of this family. Of the 55 benign meningioma cases examined, 29 were transitional, 16 were meningothelial, and 8 were fibroblastic in nature. In the meningotheliomatous cases, the MMP-11 expression score was high (75%), whereas it was low in the fibrous cases (87.5%). The Ki-67 levels in the cases with high MMP-11 expression scores were significantly higher than those of cases with low MMP-11 expression scores. Although there was no statistically significant correlation between recurrence and the MMP-11 expression score, 5 out of 7 cases with recurrence were found to have high MMP-11 expression scores. According to our study, MMP-11 is expressed in Grade I meningiomas. The level of MMP-11 expression appears to be high in the meningotheliomatous tumours and low in the fibrous subtypes. The tumours with a high level of MMP-11 expression also demonstrated high Ki-67 values.