Yazar "Tönge, Mehmet" seçeneğine göre listele
Listeleniyor 1 - 10 / 10
Sayfa Başına Sonuç
Sıralama seçenekleri
Öğe A simple technique for bone storage after decompressive craniectomy in children(Karger, 2014) Sılav, Gökalp; Bölükbaşı, Fatih Han; Özek, Erdinç; Tönge, Mehmet; Onoz, Mustafa; Elmacı, İlhanCranial vault reconstruction in the pediatric population is a specialized procedure, which requires additional considerations. Generally, inherent difficulties of bone storage and cranioplasty are neglected in the literature. We present a simple method of bone storage and autologous cranioplasty in a small child with severe head injury. The child underwent surgical treatment with decompressive craniectomy. A bone flap was transversally divided into two pieces and stored under the galea. Bone storage and reconstruction of the cranial vault with our surgical technique is a safe, easy and cost-effective choice excluding the surgical trauma to obtain a new subcutanous pocket for bone storage in pediatric decompressive craniectomy patients.Öğe Ağrı tedavisinde motor korteks stimülasyon cerrahisi(2019) Genç, Berkhan; Özbek, Muhammet Arif; Tönge, MehmetMotor korteks stimülasyonu ile ağrı kontrolü arasındaki ilişki uzun yıllardır bilinmektedir. Altta yatan mekanizma halen net anlaşılamamakla birlikte motor korteks stimülasyonu ile dirençli ağrı sendromlarında iyi sonuçlar elde edilmektedir. Özellikle üst ekstremite yayılımlı deafferentasyon ağrıları ve yüz bölgesini içeren ağrılı durumlarda yüksek etkinliği gösterilmiştir. Cerrahi teknik, epidural veya subdural olarak motor korteksin ağrı yayılımına uyan somatotopik bölgesine elektrot implantasyonunu ve bu sistemin internal bir pulse jeneratörüne bağlanmasını içermektedir. Cerrahi tekniğin epilepsi, kanama, enfeksiyon, cihaz ile ilişkili komplikasyonlar gibi riskleri bulunmakla birlikte bu komplikasyonlar nadir olarak görülmektedir. Makalede, ağrı sendromlarında motor korteks stimülasyonunun etki mekanizması, implantasyon tekniği ve klinik sonuçları tartışılmaktadır.Öğe Dosimetric phantom consistency of TMR-10 protocol in homogeneous and inhomogeneous regions in gamma knife radiosurgery planning(Haydarpaşa Numune Training and Research Hospital, 2022) Tönge, Mehmet; Yazıcı, Ömer; İpek, Veyselkarani; Acar Demir, HilalIntroduction: The algorithms used in the GammaPlan treatment planning system are “Tissue Maximum Ratio (TMR) classical,”“TMR 10,” and “convolution” algorithms, respectively. In this study, the consistency of dosimetric measurements with the TMR 10 protocol used in SRC (stereotactic radiosurgery) planning in lesions located in homogeneous and inhomogeneous regions in different intracranial location scenarios was investigated. Methods: In this study, the accuracy of administration of multiple metastasis treatment on the Gamma Knife Perfexion device was investigated. Computed tomography was performed with 1 mm cross-section intervals of CIRS brand Atom randofantoma. Critical organs and three different brain metastases located in homogeneous and heterogeneous regions, which are not on the same plane with each other, were drawn on the phantom. Planned target volume (PTV) volumes were created without margining the drawn gross tumor volumes, and three separate plans were made for three different PTV volumes. All plans were calculated using the TMR 10 algorithm. Critical organ doses were kept below the brain-SRC criteria for all calculated plans. Gafchromic EBT-3 film was placed on the sections with the target volume drawn on the phantoms and irradiated (1600 cGy, 50% isodose area). Measurements were made three times. The measured film results and the doses calculated from the planning were compared with gamma index analysis for different tolerance values. Results: In our study, for three different lesions planned and irradiated with different gradient index values, a difference of 2.11–9.58% was observed between the values calculated with the TMR-10 protocol and the values obtained in the dosimet- ric measurement. A decrease in consistency was observed, especially in inhomogeneous region placements. Discussion and Conclusion: There may be inconsistency between the TMR-10 protocol and actual dosimetric measurements, especially around inhomogeneous intracranial structures. We hope that this inconsistency will decrease in the future with the developing dose calculation protocols.Öğe Flow diverter stents in the treatment of recanalized intracranial aneurysms(SAGE Publications Inc., 2021) Akgül, Erol; Onan, Hasan Bilen; İşlek, İrem; Tönge, Mehmet; Durmuş, Yavuz; Barburoğlu, Mehmet; Azizova, Aynur; Erol, Cengiz; Hakyemez, Bahattin; Sencer, Serra; Aydın, Kubilay; Arat, AnılBackground We assessed the safety and efficacy of flow diverter stents (FDSs) in the treatment of recanalized or residual intracranial aneurysms treated endovascularly. Materials & Methods Patients whose recanalized or residual aneurysms were treated with FDSs in five tertiary hospitals were reviewed retrospectively. The patients' demographic data, aneurysm characteristics, types of previous treatment, and clinical complications, or serious adverse events associated with FDSs, as well as the results of neurological and angiographic follow-up assessments, were recorded. Results Eighty-six patients (37 males) with 87 aneurysms were included in this study. Eighty (91.9%) aneurysms were in the anterior and seven (8.1%) in the posterior circulation. The initial treatment methods were the primary coiling or balloon remodeling technique in 69 (79.3%) and stent-assisted coiling in 18 (20.7%) aneurysms. The endovascular procedure was successful in all patients. Complications occurred in four patients, for a total complication rate of 4.6%. A technical complication developed in one patient (1.2%). An in-stent thrombosis treated with tirofiban was seen in two cases. Late in-stent stenosis exceeding 50% was treated with balloon angioplasty in one patient. The mean length of follow-up was 21.0 months. The first angiographic follow-up (3-6 months) revealed the complete occlusion of 74 aneurysms (85.1%). While 76 aneurysms (87.4%) were occluded at the last angiographic follow-up (mean: 26.0 months), 11 aneurysms (12.6%) were still filling. Morbimortality was zero. Conclusion The drawback of endovascular treatment is aneurysmal remnants or recurrences, which is safely and durably amenable to flow diversion.Öğe Gamma Knife radiosurgery for the treatment of trigeminal neuralgia: A single center-experience(2024) Akçakaya, Mehmet Osman; Mirkhasilova, Muyassar; Öztürk, Onur; Uğurlar, Doğa; Tönge, Mehmet; Alço, Gül; Ercan, Tülay; İğdem, Şefik; Karadereler, SelhanIntroduction and objectives: We aimed to assess the outcomes of patients with trigeminal neuralgia (TGN) who underwent Gamma Knife radiosurgery (GKRS). Materials and methods: Fifty-three patients with typical TGN underwent GKRS from May 2012 until December 2022. Among these patients, 45 patients who were follow-up for at least 12 months were included in the study. A mean dose of 87.5 Gy (range, 80–90) was administered to the trigeminal nerve. Postoperatively, outcome was considered excellent if the patient was pain- and medication-free. Results: The mean symtpom duration was 9.53 years, and the mean patient age was 59.8 years (range, 34–85). The mean follow-up period was 46.8 months (range, 12–127 months). 46.7% of patients had a history of previous surgical interventions. A single nerve division was affected in 14 patients (31.1%), and multiple divisions were affected in 31 patients (68.9%). The rate of initial pain relief was 80%. Hypoesthesia in the area of trigeminal nerve developed in 30 (66.7%). Twenty patients (44.4%) exhibited excellent results within 72.4 months. Recurrence occurred in 11 patients (24.4%) with 27.6 months. Conclusions: Our results suggest that GKRS is a safe and effective procedure. Thus, it is an attractive first- and second-line treatment choice for TGN.Öğe History of deep brain stimulation(Nova Science Publishers, Inc., 2022) Tönge, Mehmet; Genç, Berkhan; Zırh, Tahsin AliElectrical neuromodulation of the brain comprises stereotactic surgical interventions, primarily those focusing on neurophysiological functional alterations. The term “stereotactic surgery” refers to the discipline of accessing a definite targeted area within the nervous system with imaging, a Cartesian coordinate system and three-dimensional calculation system guidance. Stereotactic surgical techniques have advanced exponentially in the last 40 years. Utilization of new calculation techniques, invention of frameless systems and image-fusion with recently available software have contributed to implementation of minimal invasive surgical approaches and considerably decreased mistargeting. Actually, initial modern work attempts have been led by psychosurgery and lesioning procedures in the second quarter of previous century, which has recently advanced to a gold standard in surgery for movement disorders via deep brain stimulation (DBS). Implementation of DBS surgery has led to lesser use of lesioning surgery. Nowadays, determination and restoration of the symptom-specific nucleus by stimulation is aimed and can be achieved. Despite all these developments and success in the field, the exact mechanisms of deep brain stimulation have not been clearly explained yet. A possible modulation of dataflow in adjacent basal ganglio-thalamo-cortical pathways by an efferent GABAergic and glutamatergic inhibitory and excitatory complex pathway output arising from nuclei stimulated by DBS is generally accepted. In the last 25 years, many animal studies have focused on the anatomy, physiology and interactions of basal ganglia with one another and with target neural areas in different disorder scenarios. Deep Brain Stimulation surgery along with the radiosurgery is the most intriguing and fast developing field in neurosurgery. Its efficacy on hypokinetic and hyperkinetic movement disorders has been proven and utility in psychosurgery is recently under research. First application for an electronic stimulation system for use in Parkinson’s disease patients to US Food and Drug Administration (FDA) department was carried out by an American company ‘Medtronic’ in March 1997. First research data including Unified Parkinson’s Disease Rating Scale (UPDRS) output have been presented to FDA. In advance, thalamic DBS for motor tremor in both Parkinson’s Disease and essential tremor was approved by FDA in 1997. The same company applied for approval to similar EU department for utilizing treatment in European countries in 1998. In 2003, sub thalamic nucleus (STN) DBS and Globus Pallidus internus (GPi) DBS for Parkinson’s Disease were approved by FDA. Afterwards, clinical use has extended to primary generalized and segmental dystonia in 2003, and obsessive compulsive disorder (OCD) in 2009 with ‘humanitarian device exemption’ (HDE) status of FDA. More recently, DBS surgery was approved by FDA for medically refractory epilepsy in 2018. Besides, DBS is recently in use successfully for disorders like Tourette’s syndrome and depression, and some case series in available literature state that the DBS can be utilized for various other disorders like headache, obesity and dementia. Reversibility of DBS effects encourage academic community for further researches. DBS procedure has been performed over 40.000 patients for Parkinson’s disease and essential tremor as of 2013. Recently, this number is estimated over 100,000. This new technology has built up hope particularly for Parkinson’s disease patients and their relatives.Öğe Microelectrode recording and stimulation in surgery for movement disorders(Nova Science Publishers, Inc., 2022) Zırh, Tahsin Ali; Tönge, MehmetIntraoperative neuronal microrecordings and stimulation can help in localizing specific targets during stereotactic surgeries. This chapter describes our technique and experience in performing a) microelectrode recording and b) thalamic ventral intermediate nucleus, globus pallidus internus and subthalamic nucleus leisoning and deep brain stimulation cases. All patients suffered from medically refractory movement disorders. Microelectrode recording and stimulation by using platinium-iridium microelectrodes with 2-4 micron tips were utilized in 1,379 consecutive cases. The findings, the advantages, as well as the risks of microelectrode recording and our stimulation technique were evaluated. The clinical experience consists of 13,556 single microelectrode recording trajectories from 1,379 medically refractory movement disorder cases. Data were gathered from 2,227 anatomical sites; 125 thalamic, 532 pallidal, and 1,570 subthalamic areas. Results and their implications are discussed.Öğe Stereotaktik supraorbital ve transorbital yaklaşımlar: Anatomik kadavra çalışması(2022) Genç, Berkhan; Tönge, MehmetTransorbital ve supraorbital minimal invaziv yaklaşımlar, orbita içi, bitişiğindeki sinüsler, kafa tabanı ve diğer intrakranial yapılara ve bu bölgedeki lezyonlara ulaşmak için tanımlanan yaklaşımlardır. Bu yaklaşımlar geleneksel yaklaşımların yarattığı kozmetik ve beyin retraksiyonuna bağlı morbiditelerin azaltılması için alternatif yollar olarak görülmektedir. Bu yollar endoskopik olarak çalışılmaya devam ediliyor olsa da stereotaktik olarak henüz bir tanımlama yapılmamıştır. Stereotaktik cerrahide kullanılan klasik giriş yerleri olan Kocher noktası ve çevresi subventriküler psikoşirurjik ve hipotalamik hedefler için komplikasyon riski görece yüksek ve zorlayıcı traseler oluşturmaktadır. Bu çalışmada supraorbital ve transorbital noktalar alternatif giriş yeri olarak çalışılmış; Nucleus Accumbens, Subcollosal singulat girus ve lateral hipotalamik alan ile oluşturulan traseler, kadavralar ve radyolojik görüntülemeler üzerinde incelenmiştir. Çalışma sonuçları incelendiğinde hipotalamik hedeflere ulaşılırken Nucleus Accumbens' inde aynı anda hedeflenebildiği, bu giriş açılarıyla elektrotların Nucleus Accumbens' in anatomik yapısına daha uygun olarak konumlandırılabildiği ve subcollosal singulat girus ile lateral hipotalamik alanı içerdiği ve uyarılmak istenen projeksiyonlar boyunca trase oluşturulabildiği görülmüştür.Öğe Surgery for intractable temporal lobe epilepsy: experience of a single institution(The Scientific and Technological Research Council of Turkey, 2014) Kurt, Gökhan; Tönge, Mehmet; Çeltikçi, Emrah; Çapraz, İrem; Serdaroğlu, Ayşe; Bilir, ErhanBackground/aim: In the treatment of epilepsy, encouraging results have been achieved with surgical treatment, especially for temporal lobe epilepsy (TLE). Drug resistance must be diagnosed as early as possible, because the ensuing seizures can be eliminated surgically via temporal lobe surgery in a high percentage (70%-90%) of patients. In this study we share our experience, in a single institution, of surgical treatment of intractable TLE. Materials and methods: Between March 2006 and November 2010 we performed 127 corticoamygdalohippocampectomy (CAH) procedures. All CAN surgical procedures were done as described by Niemeyer's technique. Resection lengths were 4-4.5 cm from the temporal pole. Results: At the end of 24 months, 79.7% (n = 94) patients were still on antiepileptic medications, with 55 of them on a decreased number or dose of drugs, and 20.3 (n = 24) patients were antiepileptic drug-free. Postoperative Engel's classes were 1, 2, and 3 in 87.2%, 5.08%, and 7.6%, respectively. There was no mortality in follow-up, and dysphasia in 1 patient (0.84%) was the only morbidity. Conclusion: In our series we found that the outcome of surgery is associated with careful patient selection, which requires a detailed investigation of the patients. Our final conclusion is that outcome scores are independent of age, pathology, or sex but are dependent on correct patient selection.Öğe The association between surgical characteristics and cognitive decline following deep brain stimulation of the subthalamic nucleus in Parkinson's disease(Elsevier, 2021) Mulders, Anne E.P.; Temel, Yasin; Tönge, Mehmet; Schaper, Frederic L. W. V. J.; van Kranen-Mastenbroek, Vivianne H.J.M.; Ackermans, Linda P.C.M.; Kubben, Pieter L.; Janssen, Marcus L.F.; Duits, Annelien A.Objective: Despite optimal improvement in motor functioning, both shortand long-term studies have reported small but consistent changes in cognitive functioning following STN-DBS in Parkinson's disease (PD). The aim of the present study was to explore whether surgical characteristics were associated with cognitive decline one year following STN-DBS.Methods: We retrospectively analyzed 49 PD patients who underwent bilateral STN-DBS. Cognitive change scores were related to the number of microelectrode recording (MER) trajectories, the STN length as measured by MER, and cortical entry points. Regression analyses were corrected for age at surgery, disease duration, education and preoperative levodopa responsiveness. Patients were then divided into a cognitive and non-cognitive decline group for each neuropsychological test and compared regarding demographic and surgical characteristics.Results: One year postoperatively, significant declines were found in verbal fluency, Stroop Color-Word test and Trail Making Test B (TMT-B). Only changes in TMT-B were associated with the coronal entry point in the right hemisphere. The number of MER trajectories and STN length were not associated with cognitive change scores. When comparing the cognitive decline and non-cognitive decline groups, no significant differences were found in surgical characteristics.Conclusions: The electrode passage through the right prefrontal lobe may contribute to subtle changes in executive function. However, only few patients showed clinically relevant cognitive decline. The use of multiple MER trajectories and a longer STN length were not associated with cognitive decline one year following surgery. From a cognitive point of view, DBS may be considered a relatively safe procedure.
