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    Comparison of the Surgical Results for Foramen Magnum Decompression with and without Duraplasty in Chiari Malformation Type 1
    (Turkish Neurosurgical Soc, 2015) Gürbüz, Mehmet Sabri; Karaarslan, Numan; Çalışkan, Tezcan; Ünal, Emre; Berkman, Mehmet Zafer
    AIM: The surgical results for foramen magnum decompression (FMD) with and without duraplasty in Chiari Malformation type 1 (CM-1) were compared retrospectively. MATERIAL and METHODS: Thirty-nine cases of CM-1 with and without syringomyelia (SM) were included.There were 18 patients in the non-duraplasty and 21 in the duraplasty group. Syringomyelia, tonsillar herniation (TH), preoperative symptom duration, and postoperative SM size were compared. RESULTS: No significant difference was found between improvement in the duraplasty group (81%) and the non-duraplasty group (61.1%). In cases whose symptom duration was 0-36 months, improvement in the duraplasty group (93%) was significantly better than in the non-duraplasty group (50%) (p<0.01). The rate of syrinx regression was 92.3% in the duraplasty group and 12.5% in the non-duraplasty group (p<0.05). In cases with SM, the improvement was 21.4% in the non-duraplasty group compared to 78.6% in the duraplasty group (p=0.056). In cases with TH greater than 10 mm, the improvement was 66.7% in the non-duraplasty group, whereas all six cases (100%) in the duraplasty group had improved. CONCLUSION: In SM associated cases, cases with TH greater than 10 mm, and whose symptom duration is less than 36 months, duraplasty is a more reliable choice despite a slightly higher rate of complications.
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    Evaluation of biopathogenesis of meningioma cases in the light of literature
    (Logos Medical Publishing, 2018) Karaarslan, Numan; Gürbüz, Mehmet Sabri; Şimşek, Abdullah Talha; Erşahin, M.; Berkman, Mehmet Zafer
    In this study, it was aimed to investigate the bio pathogenesis of the cases diagnosed with meningioma in the light of the literature. The patients (n=79) operated due to the meningioma in neurosurgery department between 2005 and 2010 were retrospectively examined. Findings that may affect the biological behavior and prognosis of the tumours recorded in these reported data were evaluated. A total of 79 cases meeting the research criteria were included in the study. When the histopathological grade of the cases was examined, it was seen that 59 cases (74.7%) were grade I and 20 cases (25.3%) were grade II. When the relation between the localization and histological grade of the cases was examined, it was determined that the meningiomas were most frequently located in convexity and that most of grade II cases were localized at this site. Preoperative peritumoral oedema was found to be more prevalent, especially in the sphenoid wing and convexity meningiomas. A total of 9 cases of recurrence (11.4%) occurred during follow-up period. When carrying out evaluation between surgical resection grade and recurrent cases, it was detected that all cases where it was performed Simpson grade IV and Kobayashi grade IVA and IVB resection had a recurrence. When the localization of recurrent cases was examined, it was seen that 4 cases (%44.4) were sphenoid wing meningioma, 2 cases (%22.2) were parasagittal meningioma, 1 case (%11.1) was tuberculosis sellae meningioma and 1 case (%11.1) was int-raventricular meningioma. In our study, histopathologic subtype and surgical resection grade were found to play a significant role in prognosis in meningiomas. It was also thought that the presence of peritumoral oedema and tumour localization could affect the biological behavior and prognosis of the meningioma. Findings obtained should be supported by multi-center studies that will include the cases of different races with more series. © 2018, Logos Medical Publishing. All rights reserved.
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    Factors Affecting on the Prognosis in Multiple Intracranial Aneurysms
    (2020) Çalışkan, Tezcan; Gürbüz, Mehmet Sabri; Yüksel, Mehmet Onur; Berkman, Mehmet Zafer
    Background: With improvements in diagnostic methods, the incidence of multiple intracranial aneurysms has increased up to35%. Factors influential on outcome in multiple intracranial aneurysms are still debatable. We aimed to determine risk factorsrelated to multiple intracranial aneurysms in patients admitted with subarachnoid hemorrhage caused by a ruptured intracranialaneurysm.Material and Methods: This retrospective study was performed on 105 aneurysms of 48 patients diagnosed with multipleaneurysms using charts, records, and film archives among 250 patients admitted to İstanbul Haydarpaşa Numune Training andResearch Hospital between January 2003-December 2009 who were examined and treated for subarachnoid hemorrhage. Age,gender, medical history, admission/surgery times, clinical features determined on neurological examination at admission (WFNSScore), amount of blood measured on cranial computed tomographic images (Fisher Score), number of aneurysms and systemsto which they belonged, complications, and Glasgow outcome scale indicating the morbidity and mortality were recorded.Results: The mean age was 52.75±14.02(4-90) years. The female/male ratio was 2.2. Most common clinical features wereheadache (83.7%), and hypertension (56.3%). The most common location was the middle cerebral artery, and aneurysm sizewas 2-6 mm (66.7%). The most common intervention was an early clipping of as many aneurysms as possible in one session(84.7%). Vasospasm and hydrocephalus were the most common complications (31.1%, 16.6%, respectively). No differencewas present between early and late interventions regarding mortality. Glasgow outcome Scale was negatively correlated withFisher score (r=-0.306), but not with WFNS score.Conclusions: Age, amount of cisternal blood preoperatively, and postoperative vasospasm are risk factors for mortality, butnot hypertension and postoperative hydrocephalus. WFNS Scoring system is not a reliable mortality predictor.
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    The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures
    (Wolters Kluwer Medknow Publications, 2016) Yüksel, Mehmet Onur; Gürbüz, Mehmet Sabri; Gök, Şevki; Karaarslan, Numan; İş, Merih; Berkman, Mehmet Zafer
    Aim: Our aim was to determine whether a combination of sagittal index (SI), canal compromise (CC), and loss of vertebral body height (LVBH) is associated with the severity of neurological injury in patients with thoracolumbar burst fractures. Materials and Methods: Seventy-four patients with thoracolumbar burst fracture undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. The degree of neurological injury was determined using the American Spinal Injury Association (ASIA) scoring system. The association between the morphology of the fracture and the severity of neurological injury was analyzed. Results: There was a strong association between fracture morphology and the severity of neurological injury. Of the patients, 77.5% with SI >= 20 degrees, 81.6% with CC >= 40%, and 100% with LVBH >= 50% had lesion according to ASIA. All of 7 patients with ASIA A had SI >= 20 degrees w, CC >= 40%, and LVBH >= 50%. On the other hand, 79% of the patients with ASIA E had SI <20 degrees, 83.7% of the patients with ASIA E had CC <40%, and all of the patients with ASIA E had LVBH <50%. SI, CC, and LVBH were lower in neurologically intact patients (ASIA E), whereas they were higher in patients with neurological deficits (ASIA A, B, C, D) (P = 0.001; P < 0.01). These measurements had 100% negative predictive values and relatively high positive predictive values. Conclusion: SI, CC, and LVBH are significantly associated with the severity of neurological injury in patients with thoracolumbar burst fractures. The patients with SI >25 degrees, the patients with CC >40%, and the patients with LVBH >50% are likely to have a more severe neurological injury.
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    The Effect of Matrix Metalloproteinase-3 on the Prognosis and Biological Behaviour of Meningiomas
    (Turkish Neurosurgical Soc, 2016) Karaarslan, Numan; Gürbüz, Mehmet Sabri; Çalışkan, Tezcan; Ayan, Erdoğan; Vardar Aker, Fugen; Berkman, Mehmet Zafer
    AIM: To analyse the effect of MMP-3 (Matrix Metalloproteinase Enzyme-3)-one of the extracellular matrix proteins-on the prognosis and biological behaviour of meningiomas. MATERIAL and METHODS: 79 cases of meningioma that were operated in our clinic between 2005 and 2010 were retrospectively analysed. Age, sex, preoperative peritumoral edema, histological subtype, grade, Ki-67 expression, MMP-3 staining pattern and recurrence rate were analysed. Pathological preparations were graded according to the WHO (World Health Organisation) 2007 grading system. RESULTS: Of the MMP-III positive cases; 24 cases (60%) were grade I, 16 cases were grade II. The MMP-3 staining pattern was significantly positive (80%) in grade II meningioma. 14 of the MMP-3 positive cases were atypical meningiomas. Of the 20 cases with high Ki-67 proliferation index (PI), 12 cases (60%) were MMP-3 positive and 8 cases (40%) were MMP-3 negative. Rates of recurrence and preoperative peritumoral edema were high in cases with MMP-3 positivity. CONCLUSION: In this study it was determined that MMP-3 positivity has a strong relationship with meningiomas having an aggressive character. MMP-3 may be used as a proliferation marker for biological behaviour, recurrence rate and prognosis of meningiomas.
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    Tip 1 Chiari Malformasyonlu Hastalarda Duraplastili ve Duraplastisiz Foramen Magnum Dekompresyonunun Cerrahi Sonuçlarının Karşılaştırılması
    (2015) Gürbüz, Mehmet Sabri; Karaarslan, Numan; Çalışkan, Tezcan; Ünal, Emre; Berkman, Mehmet Zafer
    AMAÇ: Bu retrospektif çalışmada tip 1 Chiari Malformasyonlu (CM-1) hastalarda duraplastili ve duraplastisiz foramen magnum dekompresyonunun cerrahi sonuçları karşılaştırılmıştır. yÖNTEM ve GErEÇLEr: Sirengomyeli (SM) bulunan ve bulunmayan 39 CM-1 olgusu çalışmaya dahil edildi.duraplastisiz grupta 18, duraplastili grupta 21 olgu bulunmaktaydı. SM varlığı, tonsiler hernniasyon (TH) miktarı, preoperatif semptom süresi ve postoperatif SM boyutu karşılaştırıldı. BuLGuLAr: Duraplastili (%81) ve duraplastisiz grubun (%61,1) iyileşme oranları arasında anlamlı fark bulunmadı. Preoperatif semptom süresi 0-36 ay arasında olan olgularda; duraplastili grubun iyileşme oranı (%93) duraplastisiz gruba göre (%50) anlamlı oranda yüksekti (p<0.05). Sirenks boyutunda küçülme oranı duraplastili grupta % 92,3 iken duraplastisiz grupta % 12.5 idi (p<0.05). SM bulunan olgularda; duraplastili grubun iyileşme oranı % 78,6, duraplastisiz grubun iyileşme oranı ise % 21,4 idi (p=0.056). TH'un 10 mm'den fazla olduğu olgularda; duraplastisiz grubun iyileşme oranı % 66,7 iken, duraplastili 6 olgunun tamamı iyileşmişti (%100). soNuÇ: SM'li olgularda, TH'un 10 mm'den fazla olduğu olgularda ve semptom süresi 36 aydan kısa olan olgularda duraplasti hafif yüksek komplikasyon oranı olmakla birlikte daha iyi bir seçenek olarak düşünülmüştür.