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    Comparison of clinical and radiologic outcomes between dural splitting and duraplasty for adult patients with chiari type I malformation
    (Georg Thieme Verlag, 2023) Özbek, Muhammet Arif; Başak, Ahmet Tulgar; Çakıcı, Nazlı; Evran, Şevket; Kayhan, Ahmet; Saygı, Tahsin; Baran, Oğuz
    Background The most used surgical procedure in the treatment of patients with Chiari type I malformation (CIM) is posterior fossa decompression. However, no consensus has been reached regarding the superiority of either dural splitting or duraplasty. Thus, the aim of this study was to compare clinical and radiologic outcomes between the two techniques used in consecutive patients. Methods We retrospectively reviewed 74 adult patients with CIM who were diagnosed and treated surgically between 2015 and 2020 at our neurosurgery department. The patients were divided into two groups: dural splitting in group 1 and duraplasty in group 2. Clinical outcomes based on Chicago Chiari Outcome Scale (CCOS) scores at the last control visits were compared between the groups. Radiologic outcomes were compared in terms of tonsillar regression rate based on 12-postoperative-month magnetic resonance images. Results Overall improved, unchanged, and worsened neurologic statuses were observed in 75.6% ( n = 56), 17.5% ( n = 13), and 6.7% ( n = 5) of our patients, respectively. The mean last visit CCOS scores in groups 1 and 2 were 12.3 +/- 2.1 and 13.5 +/- 1.7, respectively. The difference between the groups was statistically significant ( p < 0.01). The mean tonsillar regression rates were 34.7 +/- 17.0% and 52.1 +/- 15.3% in groups 1 and 2, respectively, with a statistically significant difference ( p < 0.001). Conclusion Adult patients undergoing duraplasty had better clinical and radiologic outcomes than those treated with dural splitting. Therefore, we recommend decompression with duraplasty for adult CIM patients.
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    Efficacy of middle meningeal artery embolization in treatment resistant spontaneous intracranial hypotension caused subdural hematoma: Report of two cases and review of the literature
    (Korean Neurosurgical Society, 2022) Evran, Şevket; Kayhan, Ahmet; Saygı, Tahsin; Özbek, Muhammet Arif; Kılıçkesmez, Özgür
    Spontaneous intracranial hypotension (SIH) most commonly manifests as bilateral subdural hematoma (SH). SIH cases mostly resolve spontaneously but further treatment would be needed via blind epidural blood patch (EBP). Cerebrospinal fluid (CSF) leakage in EBP-refractory cases can be treated surgically only if the localization of CSF leakage is detectable but it cannot be possible in most of the cases. Also surgical evacuation of SH secondary to SIH (SH-SIH) is not favorable without blocking the CSF leakage. Thus the management of these patients is a challenge and alternative treatment options are needed. Although middle meningeal artery embolization (MMAE) is an effective treatment option in non-SIH SH, there is no report about its application in the treatment of SH-SIH. We present two cases of SH-SIH which their clinical and radiological findings were completely resolved by bilateral MMAE treatment.
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    Preoperative tomographic needle marking: A novel level localization method to avoid wrong-level spine surgery in upper thoracic lesions
    (AVES, 2023) Saygı, Tahsin; Kayhan, Ahmet; Evran, Şevket; Akkaya, Enes
    Objective: The objective of this study is to reduce the incidence of wrong-level surgery in upper thoracic spinal surgery. Methods: The data of 26 patients whose level was determined by the preoperative fluoroscopy method and 21 patients whose level was determined by the preoperative computed tomography method were analyzed and compared statistically. Results: A statistically significant difference was identified in the rate of wrong-level surgery between the groups. The rate of additional laminectomy due to wrong-level surgery in the preoperative fluoroscopy group was statistically significantly higher than in the preoperative computed tomography group (P = .026). In addition, the average time from positioning to incision in the preoperative fluoroscopy group was found to be statistically significantly higher than in the preoperative computed tomography group (P < .001). Conclusion: The preoperative computed tomography method provides a shorter surgical time and reduces the incidence of wrong-level surgery compared to the preoperative fluoroscopy method.
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    The association between calreticulin and glucagon-like peptide-1 expressions with prognostic factors in high-grade gliomas
    (2024) Baran, Oğuz; Akgün, Mehmet Yiğit; Kayhan, Ahmet; Evran, Şevket; Özbek, Muhammet Arif; Akyoldaş, Göktuğ; Samancı, Mustafa Yavuz; Demirel, Nail; Sönmez, Derya; Serin, Huriye; Koçak, Ayhan; Kemerdere, Rahşan
    Objective: The aim of this study is to present the expressions of Calreticulin (CALR) and Glucagon-like peptide-1 (GLP-1) in high-grade gliomas and to further show the relation between the levels of these molecules and Ki-67 index, presence of Isocitrate dehydrogenase (IDH)-1 mutation, and tumor grade. Patients and Methods: A total of 43 patients who underwent surgical resection due to high-grade gliomas (HGG) (grades III and IV) were included. The control group comprised 27 people who showed no gross pathology in the brain during the autopsy procedures. Adequately sized tumor samples were removed from each patient during surgery, and cerebral tissues were removed from the control subjects during the autopsy procedures. Each sample was stored at -80°C as rapidly as possible until the enzyme assay. Results: Patients with high-grade gliomas showed significantly higher levels of CALR and significantly lower levels of GLP-1 when compared to control subjects (P = 0.001). CALR levels were significantly higher, GLP-1 levels were significantly lower in grade IV gliomas than those in grade III gliomas (P = 0.001). Gliomas with negative IDH-1 mutations had significantly higher CALR expressions and gliomas with positive IDH-1 mutations showed significantly higher GLP-1 expressions (P = 0.01). A positive correlation between Ki-67 and CALR and a negative correlation between Ki-67 and GLP-1 expressions were observed in grade IV gliomas (P = 0.001). Conclusions: Our results showed that higher CALR and lower GLP-1 expressions are found in HGGs compared to normal cerebral tissues.