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Three-dimensional reconstruction of the topographical cerebral surface anatomy for presurgical planning with free osirix software

Harput, M.V. | Gonzalez-Lopez, P. | Türe, U.

Article | 2014 | Operative Neurosurgery10 ( 3 ) , pp.426 - 435

BACKGROUND: During surgery for intrinsic brain lesions, it is important to distinguish the pathological gyrus from the surrounding normal sulci and gyri. This task is usually tedious because of the pia-arachnoid membranes with their arterial and venous complexes that obscure the underlying anatomy. Moreover, most tumors grow in the white matter without initially distorting the cortical anatomy, making their direct visualization more difficult. OBJECTIVE: To create and evaluate a simple and free surgical planning tool to simulate the anatomy of the surgical field with and without vessels. METHODS: We used free computer software (Osir . . .iX Medical Imaging Software) that allowed us to create 3-dimensional reconstructions of the cerebral surface with and without cortical vessels. These reconstructions made use of magnetic resonance images from 51 patients with neocortical supratentorial lesions operated on over a period of 21 months (June 2011 to February 2013). The 3-dimensional (3-D) anatomic images were compared with the true surgical view to evaluate their accuracy. In all patients, the landmarks determined by 3-D reconstruction were cross-checked during surgery with high-resolution ultrasonography; in select cases, they were also checked with indocyanine green videoangiography. RESULTS: The reconstructed neurovascular structures were confirmed intraoperatively in all patients. We found this technique to be extremely useful in achieving pure lesionectomy, as it defines tumor's borders precisely. CONCLUSION: A 3-D reconstruction of the cortical surface can be easily created with free OsiriX software. This technique helps the surgeon perfect the mentally created 3-D picture of the tumor location to carry out cleaner, safer surgeries. © 2014 by the Congress of Neurological Surgeons Daha fazlası Daha az

The paramedian supracerebellar-transtentorial approach for a tentorial incisura meningioma: 3-dimensional operative video

Manilha, R. | Harput, V.M. | Türe, U.

Article | 2018 | Operative Neurosurgery15 ( 1 ) , pp.426 - 435

[No abstract available]

Spinal accessory nerve monitoring in posterior fossa surgery

Karlikaya, G. | Çitçi, B. | Güçlü, B. | Türe, H. | Türe, U. | Bingöl, Canan Aykut

Article | 2008 | Journal of Clinical Neurophysiology25 ( 6 ) , pp.346 - 350

The role of intraoperative monitoring of lower cranial nerves is not well established. In this study, the authors retrospectively analyzed the intraoperative monitoring data and the clinical outcome of the spinal accessory nerve (SAN) in patients who have undergone posterior fossa surgery. SAN was monitored in 19 patients. Subcutaneous needle electrodes were placed in the trapezius, and any abnormal spontaneous activity was documented for duration and amplitude. A bipolar stimulation probe was used for triggered electromyogram, with a maximum stimulation intensity of 3 mA. All patients were clinically evaluated for SAN dysfunction p . . .ostoperatively 24 hours and 7 days. Neurotonic discharges, lasting between 3 and 90 minutes were seen in 84% of the patients. Continuous discharges lasting longer than 5 minutes were seen in 36% of the patients. The SAN was stimulated in 57.8% of the patients. With clinical examination, none of our patients had postoperative SAN dysfunction. Long lasting dense neurotonic discharges and high stimulation thresholds have been correlated with postoperative facial nerve injury; however, this does seem be true in the case of SAN monitoring. Neurotonic discharges are commonly false-positive and stimulation intensity up to 3 mA can be related with a good outcome. The intraoperative monitoring of SAN may not be valuable as much as facial nerve monitoring. Copyright © 2008 American Clinical Neurophysiology Society Daha fazlası Daha az

Effect of the degree of head elevation on the incidence and severity of venous air embolism in cranial neurosurgical procedures with patients in the semisitting position

Türe, H. | Harput, M.V. | Bekiroglu, N. | Keskin, Ö. | Köner, Ö. | Türe, U.

Article | 2018 | Journal of Neurosurgery128 ( 5 ) , pp.1560 - 1569

OBJECTIVE: The semisitting position of a patient confers numerous advantages in various neurosurgical procedures, but venous air embolism is one of the associated complications of this position. To date, no prospective studies of the relationship between the degree of head elevation and the rate and severity of venous air embolism for patients undergoing a procedure in this position have been performed. In this study, the authors compared changes in the severity of venous air embolism according to the degree of head elevation (30° or 45°) in patients undergoing an elective cranial neurosurgical procedure in the semisitting position. . . . METHODS: One hundred patients undergoing an elective infratentorial craniotomy in the semisitting position were included, and each patient was assigned to 1 of 2 groups. In Group 1, each patient’s head was elevated 30° during surgery, and in Group 2, each patient’s head elevation was 45°. Patients were assigned to their group according to the location of their lesion. During surgery, the standard anesthetic protocol was used with total intravenous anesthesia, and transesophageal echocardiography was used to detect air in the blood circulation. Any air embolism seen on the echocardiography screen was classified as Grade 0 to 4. If multiple events occurred, the worst graded attack was used for statistical analysis. During hemodynamic changes caused by emboli, fluid and vasopressor requirements were recorded. Surgical and anesthetic complications were recorded also. All results were compared statistically, and a p value of < 0.05 was considered statistically significant. RESULTS: There was a statistically significant difference between groups for the total rates of venous air emboli detected on transesophageal echocardiography (22.0% [n = 11] in Group 1 and 62.5% [n = 30] in Group 2; p < 0.0001). The rate and severity of air embolism were significantly lower in Group 1 than in Group 2 (p < 0.001). The rates of clinically important venous air embolism (Grade 2, 3, or 4, venous air embolism with decreased end-tidal carbon dioxide levels and/or hemodynamic changes) were 8.0% (n = 4) in Group 1 and 50.0% (n = 24) in Group 2 (p < 0.0001). There was no association between the rate and severity of venous air embolism with patient demographics (p > 0.05). An association was found, however, between the rate of venous air embolism and the type of surgical pathology (p < 0.001); venous embolism occurred more frequently in patients with a meningioma. There were no major surgical or anesthetic complications related to patient position during the postoperative period. CONCLUSIONS: For patients in the semisitting position, an increase in the degree of head elevation is related directly to a higher rate of venous air embolism. With a 30° head elevation and our standardized technique of positioning, the semisitting position can be used safely in neurosurgical practice. © AANS, 2018 Daha fazlası Daha az

Surgical approaches to the temporal horn: An anatomic analysis of white matter tract interruption

Kadri, P.S. | De Oliveira, J.G. | Krayenbühl, N. | Türe, U. | De Oliveira, E.P.L. | Al-Mefty, O. | Ribas, G.C.

Article | 2017 | Operative Neurosurgery13 ( 2 ) , pp.258 - 270

Historical controversies about the thalamus: From etymology to function

Serra, C. | Guida, L. | Staartjes, V.E. | Krayenbühl, N. | Türe, U.

Article | 2019 | Neurosurgical Focus47 ( 3 ) , pp.258 - 270

The analgesic effect of gabapentin as a prophylactic anticonvulsant drug on postcraniotomy pain: A prospective randomized study

Türe, H. | Sayin, M. | Karlikaya, G. | Bingol, C.A. | Aykac, B. | Türe, U.

Article | 2009 | Anesthesia and Analgesia109 ( 5 ) , pp.1625 - 1631


Characterization of cancer stem-like cells in chordoma. Laboratory investigation

Aydemir, E. | Bayrak, O.F. | Şahin, Fikrettin | Atalay, B. | Kose, G.T. | Ozen, M. | Türe, U.

Article | 2012 | Journal of Neurosurgery116 ( 4 ) , pp.810 - 820

Object. Chordomas are locally aggressive bone tumors known to arise from the remnants of the notochord. Because chordomas are rare, molecular studies aimed at developing new therapies are scarce and new approaches are needed. Chordoma cells and cancer stem-like cells share similar characteristics, including self-renewal, differentiation, and resistance to chemotherapy. Therefore, it seems possible that chordomas might contain a subpopulation of cancer stem-like cells. The aim of this study is to determine whether cancer stem-like cells might be present in chordomas. Methods. In this study, the authors used gene expression analysis f . . .or common cancer stem-like cellmarkers, including c-myc, SSEA-1, oct4, klf4, sox2, nanog, and brachyury, and compared chordoma cells and tissues with nucleus pulposus tissues (disc degenerated nontumorigenic tissues). Differentiation through agents such as all-trans retinoic acid and osteogenic differentiation medium was induced to the chordoma cells. Additionally, U-CH1 cells were sorted via magnetic cell sorting for stem cell markers CD133 and CD15. After separation, positive and negative cells for these markers were grown in a nonadherent environment, soft agar, to determine whether the presence of these cancer stem-like cells might be responsible for initiating chordoma. The results were compared with those of untreated cells in terms of migration, proliferation, and gene expression by using reverse transcriptase polymerase chain reaction. Results. The results indicate that chordoma cells might be differentiating and committing into an osteogenic lineage when induced with the osteogenic differentiation agent. Chordoma cells that are induced with retinoic acid showed slower migration and proliferation rates when compared with the untreated cells. Chordoma cells that were found to be enriched by cancer stem-like cell markers, namely CD133 and CD15, were able to live in a nonadherent soft agar medium, demonstrating a self-renewal capability. To the authors' knowledge, this is the first time that cancer stem-like cell markers were also found to be expressed in chordoma cells and tissues. Conclusions. Cancer stem-like cell detection might be an important step in determining the recurrent and metastatic characteristics of chordoma. This finding may lead to the development of new approaches toward treatments of chordomas Daha fazlası Daha az


Bayrak, Ö.F. | Gulluoglu, S. | Aydemir, E. | Türe, U.

Letter | 2013 | Journal of Neurosurgery118 ( 4 ) , pp.810 - 820

[No abstract available]

Anterolateral extradural approach for C2-C3 disc herniation: Technical case report

Türe, U. | Güçlü, B. | Naderi, S.

Article | 2008 | Neurosurgical Review31 ( 1 ) , pp.117 - 121

High cervical disc herniations (C2-C3) are extremely rare, and various approaches have been used to treat C2-C3. In this report, we recommend the anterolateral extradural approach as an alternative to treat C2-C3 disc herniation. A 72-year-old woman was referred to us with severe pain in the left side of her neck and occipital region. She had been taking high doses of analgesics but had no myelopathic symptoms. Magnetic resonance imaging of the cervical spine revealed that left paramedian, extruded C2-C3 disc material was compressing the spinal cord and the left C3 nerve root. A left-sided anterolateral extradural approach was done . . .to remove the extruded disc material at the C2-C3 level. After resection of the transverse processes of C1 and C2, the V3 segment of the vertebral artery was mobilized posteromedially. The extruded disc material was carefully removed, and the vertebral artery was freed and repositioned. The anterolateral extradural approach to a C2-C3 disc herniation is a good alternative, especially in patients with thick or short necks. © 2007 Springer-Verlag Daha fazlası Daha az

The paramedian supracerebellar-transtentorial approach to remove a posterior fusiform gyrus arteriovenous malformation

Harput, M.V. | Türe, U.

Article | 2017 | Neurosurgical focus43 ( Video ) , pp.117 - 121

This is the case of a 14-year-old female who presented with headache and seizures. Cranial magnetic resonance imaging revealed an arteriovenous malformation (AVM) located at the posterior portion of the right-sided fusiform gyrus. Cerebral angiography showed that the AVM was fed mainly by branches from the inferior temporal trunk of the posterior cerebral artery. The main venous drainage was to the right transverse sinus through the tentorial vein. The AVM was totally excised through the paramedian supracerebellar-transtentorial approach with the patient in a semisitting position. Postoperative MRI and cerebral angiography confirmed . . . the total resection. The patient was discharged on the 5th postoperative day without neurological deficit. The video can be found here: Daha fazlası Daha az

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