Browsing by Author "Silav, Gokalp"

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Anatomy of Meckel's Cave and the Trigeminal Ganglion: Anatomical Landmarks for a Safer Approach to Them
(TURKISH NEUROSURGICAL SOC, 2012-01-01) Arslan, Mehmet; Deda, Haluk; Avci, Emel; Elhan, Alaittin; Tekdemir, Ibrahim; Tubbs, R. Shane; Silav, Gokalp; Yilmaz, Erdal; Baskaya, Mustafa Kemal
AIM: Surgical approaches to Meckel's cave (MC) are often technically difficult and sometimes associated with postoperative morbidity. The relationship of surgical landmarks to relevant anatomy is important. Therefore, we attempted to delineate quantitatively their anatomy and the relationships between MC and surrounding structures. MATERIAL and METHODS: With the aid of a surgical microscope, MC and its contents were studied in 15 formalin-fixed cadaver head specimens. Measurements were made and their relationships were observed. RESULTS: The distance from the zygomatic arch and the lateral end of the petrous ridge to MC was 26.5 and 34.4 mm, respectively. The distance from the arcuate eminence, the facial nerve hiatus, and the foramen spinosum to MC was 16.6, 12.8 and 7.46 mm respectively. The TG lay 5.81 mm posterior to the foramen ovale. The distance from the abducens, trochlear and oculomotor nerves to the trigeminal ganglion was 1.87, 5.53 and 6.57 mm respectively. The distance from the posterior and the anterior walls of the sigmoid sinus to the trigeminal porus was 43.6 and 33.1 mm respectively. The trigeminal porus was on average 7.19 mm from the anterior wall of the internal acoustic meatus. CONCLUSION: The anatomical landmarks as presented herein regarding MC may be used for a safer skull base approach to the region.
Concurrent Repair of Orbital Shallowness with Craniosynostosis Surgery: Two Late Cases of Simultaneous Orbital Decompression
(TURKISH NEUROSURGICAL SOC, 2013-01-01) Oreroglu, Ali Riza; Silav, Gokalp; Ozkaya, Ozay; Orman, Cagdas; Akan, Mithat
Early closure of cranial sutures results in various types of cranial vault deformities, named craniosynostosis. Although mostly associated with syndromic cases, bony orbit deformities such as exorbitism can be seen with various types of craniosynostosis. This condition can be associated with papilledema and besides its effect on the patient's appearance can cause subluxation of the globe, lagophthalmos or keratitis resulting in corneal ulcers and ultimately loss of vision. Various techniques have been proposed for repair or exorbitism such as fronto-orbital advancement procedures, orbital wall decompression, periosteum scoring and tissue excision. Orbital periosteal scoring covering the globe can be extremely efficient for orbital fat decompression when combined with other orbital volume expanding procedures. We hereby present two late cases of craniosynostosis associated with bilateral exorbitism due to orbital shallowness for which cranial vault reconstruction was performed simultaneously with combinations of fronto-orbital advancement, orbital decompression and periosteal scoring. The late referral of these patients at ages older than the usual time of operation indication made the surgical procedure for craniosynostosis repair and exorbitism treatment challenging. The combined and simultaneous use of bone advancement, orbital wall decompression and specially periosteum scoring can be highly efficient in the treatment of exorbitism associated with craniosynostosis.
Diagnosis and Management of Pituitary Abscess: A Case Series and Review of the Literature
(TURKISH NEUROSURGICAL SOC, 2013-01-01) Altas, Murat; Serefhan, Alpay; Silav, Gokalp; Cerci, Ajlan; Coskun, Kerim Kenan; Elmaci, Ilhan
AIM: Pituitary abscess is a disorder characterized with central nervous system (CNS) infection, mass effect, and endocrine dysfunction. These abscesses generally occur due to hematogenous spread in conditions such as paranasal sinusitis, sepsis, and where the blood brain barrier breaks down. This paper aims to discuss four cases of preoperatively diagnosed pituitary abscess in the light of the literature. MATERIAL and METHODS: Following detailed clinical and hormonal examinations and imaging tests, 210 cases of pituitary adenoma and other sellar pathologies were operated on at the Neurosurgery clinic of Goztepe Training and Research Hospital. RESULTS: All the patients showed fever, systemic signs of toxemia and endocrine dysfunction at the time of diagnosis. In these cases, a preoperative diagnosis of the disease was made thanks to characteristic MRI findings. The four cases were operated by the transnasal transsphenoidal approach and histopathological and microbiological studies were performed for surgical specimens. CONCLUSION: Pituitary abscesses are rare disorders responsible for a high mortality risk. Mortality and morbidity can be reduced by early surgical drainage and appropriate antibiotic treatments. Additionally, these cases should be closely followed-up in terms of pituitary insufficiency, surgical complications and infection.
Intraoperative Neurophysiological Monitoring to Prevent New Neurological Deficits in Spinal Tumor Cases
(TURKISH NEUROLOGICAL SOC, 2014-01-01) Aydinlar, Elif Ilgaz; Dikmen, Pinar Yalinay; Silav, Gokalp; Berkman, Mehmet Zafer; Elmaci, Ilhan; Ozgen, Serdar
Objective: Intraoperative neurophysiological monitoring was carried out in patients with spinal cord tumors. These patients were retrospectively evaluated for new postoperative neurological deficits. Materials and Methods: A total of 32 spinal tumor cases (8 cervical, 14 thoracic, 10 lumbosacral), 17 male and 15 female, patients between 2-66 years of age (mean 44.1 +/- 20) operated in our center were evaluated. All of our cases were monitored with somatosensory evoked potentials (SEP) muscular motor evoked potentials (MEP) and free run electromyography. Spinal MEP (D wave), bulbocavernosus reflex (BCR) and pudendal SEP were obtained in appropriate cases. Results: Five cases presented with temporary new postoperative neurological deficits in the form of strength loss. Neurophysiological recordings of all of these patients showed either temporary or permanent deterioration during surgery. The tumor was removed completely or almost completely in 26, near-completely in 4 and partially in 2 cases and none of our cases had a new permanent deficit. Conclusion: The functional integrity of the lateral and dorsal columns of the spine can be assessed by SEP and muscular MEP recording. Additional information about the neurological tissue is given by spinal MEP, BCR and pudendal SEP in suitable cases. We did not experience any false positive or negative results in our cases and we believe that the combined use of intraoperative spinal and MEP in spinal column located tumors gives reliable information about postoperative neurological outcome.
Investigation of ACE Genome Insertion/Deletion Correlation with Immunohistochemical Profile in Pituitary Adenomas
(TURKISH NEUROSURGICAL SOC, 2013-01-01) Altas, Murat; Bayrak, Omer Faruk; Serefhan, Alpay; Silav, Gokalp; Coskun, Kerim Kenan; Cerci, Ajlan; Isik, Nejat; Elmaci, Ilhan
AIM: The deletion polymorphism of the angiotensin-converting enzyme (ACE) genome causes neoplastic development in several organs by increasing the angiotensin 2 (A2) formation. In this study, we aimed to identify the ACE genome insertion/deletion polymorphism in pituitary adenomas and to compare it with the control group. MATERIAL and METHODS: Patients operated for pituitary adenomas were included in the study. Genomic DNA was extracted from tumoral tissues and peripheral blood samples of the patients by using the Miller method. Primary sequence was selected via targeting the polymorphic region of intron 16 of ACE genome 17q23. DNA samples were multiplied by PCR using HACE3s and HACE3as primers. RESULTS: Twenty-one operated cases were studied. In the study group
The Surgical Treatment of Plagiocephaly
(TURKISH NEUROSURGICAL SOC, 2011-01-01) Silav, Gokalp; Avci, Gulden; Akan, Mithat; Taylan, Gaye; Elmaci, Ilhan; Akoz, Tayfun
AIM: Anterior plagiocephaly usually occurs with premature synostosis of the ipsilateral half of the coronal suture. The forehead is flattened on the affected side, with a backward and upward displacement of the affected orbit. The bulging of the calvaria may occur in the contralateral parietal area. MATERIAL and METHODS: This article presents the surgical techniques used over 7 years to treat plagiocephalic children. Eleven patients with unilateral coronal synostosis treated during 2003-2010 were analyzed retrospectively. The study included reviews of pre and postoperative computed tomography scans, operative techniques, clinical outcomes and complications. Unilateral orbital advancement with ``tongue in groove{''} was performed in 5, and bilateral orbital advancement in 6 cases. Pre and postoperative anthropometric measurements were used to document the amount of advancement of the elevated and recessed orbita, and the amount of withdrawal of the contralateral side. RESULTS: The mean age of the patients at time of surgery was 11 months. The preoperative values of the orbital height and retrusion were 0.68 cm and 1.87 cm, respectively. They were recorded as -0.1cm and 0,63 cm, postoperatively. Mean follow-up was 36 months, neither neurological sequelae nor other significant complications were encountered. CONCLUSION: The surgical corrections have resulted in significant improvements in skull shape and high patient/parent satisfaction.