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    Effects of Modified Osteoplastic Pterional Craniotomy on Temporal Muscle Volume and Frontal Muscle Nerve Function
    (2022) Seçer, Mehmet; Çam, İsa; Gökbel, Aykut; Ulutaş, Murat; Çakır, Özgür; Ergen, Anıl; Çınar, Kadir
    Introduction ?Pterional craniotomy is a surgical approach frequently used in aneurysm and skull base surgery. Pterional craniotomy may lead to cosmetic and functional problems, such as eyebrow drop due to facial nerve frontal branch damage, temporal muscle atrophy, and temporomandibular joint pain. The aim was to compare the postoperative effects of our modified osteoplastic craniotomy with classical pterional craniotomy in terms of any change in volume of temporal muscle and in the degree of frontal muscle nerve damage. Materials and Methods ?Aneurysm cases were operated with either modified osteoplastic pterional craniotomy or free bone flap pterional craniotomy according to the surgeon's preference. Outcomes were compared in terms of temporal muscle volume and frontal muscle nerve function 6 months postoperatively. Results ?Preoperative temporal muscle volume in the modified osteoplastic pterional and free bone flap pterional craniotomy groups were not different (p > 0.05). However, significantly less atrophy was observed in the postoperative temporal muscle volume of the osteoplastic group compared with the classical craniotomy group (p < 0.001). In addition, when comparing frontal muscle nerve function there was less nerve damage in the modified osteoplastic pterional craniotomy group compared with the classical craniotomy group, although this did not reach significance (p > 0.05). Conclusion ?Modified osteoplastic pterional craniotomy significantly reduced atrophy of temporal muscle and caused proportionally less frontal muscle nerve damage compared with pterional craniotomy, although this latter outcome was not significant. These findings suggest that osteoplastic craniotomy may be a more advantageous intervention in cosmetic and functional terms compared with classical pterional craniotomy.
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    Outcomes of Microsurgical Clipping in Middle Cerebral Artery Aneurysms
    (Ordu Üniversitesi, 2021) Seçer, Mehmet; Gökbel, Aykut
    Objective: Surgical or endovascular treatment is used in the treatment of intracranial aneurysms. Recent studies have suggested that the of endovascular treatment are superior to surgery Middle cerebral artery (MCA) aneurysm is the third most common bleeding aneurysm after anterior communicating artery and internal carotid artery aneurysms. We aimed to retrospectively evaluate the microsurgical outcomes of cases operated for MCA aneurysm.Methods: Twenty cases with MCA aneurysm who accepted the microsurgical treatment option were included in this study. Data were obtained by retrospectively reviewing the clinical, radiological, and intraoperative findings, as well as postoperative morbidity and mortality of the cases.Results: In total, 23 MCA aneurysms were detected in 20 cases. In 2 cases, MCA aneurysm was detected incidentally. Microsurgical clipping was performed in 23 aneurysms. In the study, the total mortality rate was 10% and the morbidity rate was 20% in MCA aneurysms.Conclusion: It was observed that the incidence of calcification or thrombosis within the aneurysm increased and the Glasgow outcome scores at the 3rd month decreased as the width and length values of the aneurysm sac increased. In addition, presence of calcification in the aneurysm wall or thrombosis in the sac was found to be positive and strongly correlated with mortality and morbidity.
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    Results of Microvascular Decompression Surgery in the Treatment of Trigeminal Neuralgia
    (2021) Seçer, Mehmet; Gökbel, Aykut
    INTRODUCTION: Trigeminal neuralgia (TN) develops as a result of the trigger of one or more branches of the trigeminal nerve by stimuli. Most cases of TN are usually caused by compression of the trigeminal nerve root, within a few millimeters from its exit from the pons. In this study, we aimed to present our experience regarding the microvascular decompression surgical approach and itsresults in the treatment of patients who applied to the clinic with a diagnosis of TN and who did not respond to any of the treatments. METHODS: Microvascular decompression (MVD)surgery was performed on a total of 7 patients with TN who applied to the clinic between 2020 and 2021, and the information of the patients was retrospectively evaluated using surgery reports, epicrisis, and magnetic resonance images (MRI). RESULTS: It was observed that all 7 patients with TN were initially administrated carbamazepine and/or oxcarbazepine, implemented radiofrequency thermocoagulation treatment and gamma knife radiosurgery. Subsequently, all the patients underwent MVD surgery. No complications developed in the postoperative period and complaints of TN in all patients completely resolved in the early period. DISCUSSION AND CONCLUSION: In patients who are unresponsive to treatments, thin-section ‘constructive interference of steady state (CISS)’ sequence cranial MRI are useful to detect trigeminal nerve compression caused by intracranial pathologies, and MVD surgery is important in the treatment.
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    Surgical management and its outcomes in distal anterior cerebral artery aneurysms
    (2021) Seçer, Mehmet; Gökbel, Aykut
    The present study aimed to discuss the clinical and surgical outcomes of patients who underwent surgery for distal anterior cerebral artery aneurysm (DACA). Surgery for DACA aneurysms differs from other intracranial aneurysms and has its own challenges. The study included nine patients with DACA aneurysm who consented to undergo microsurgical treatment. The study data were collected by retrospectively reviewing the clinical, radiological, and intraoperative findings, as well as postoperative morbidity and mortality outcomes. A total of ten DACA aneurysms were detected in nine cases. Microsurgical treatment was performed for nine aneurysms. The multiple aneurysm rate was 33.3%. While no morbidity was observed in patients with DACA aneurysm in this study, the mortality rate was 11.1%. The surgery for DACA aneurysms is complicated due to challenges, such as difficulty in achieving proximal control, narrow working space, and difficulty in dissection due to tight adhesion of the aneurysm to the surrounding tissues. For these reasons, surgical outcomes may be adversely affected. Surgical clipping can be performed using appropriate surgical approach and microsurgical techniques.
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    Thoracic Spinal Stenosis: Surgical Approaches and Outcomes
    (Ordu Üniversitesi, 2021) Gökbel, Aykut; Seçer, Mehmet; Gokbel, Tugba
    Objective: Thoracic spinal stenosis (TSS) develops as a result of decreased spinal canal volume in the thoracic spine. The prevalence of TSS is low as when compared with cervical or lumbar spinal stenosis, and conservative treatment is not effective. The present study aimed to present all surgical methods employed and their outcomes in patients diagnosed with TSS in our clinic.Methods: In this study, the data of 14 patients including three patients with single-level, nine patients with two-level, one patient with three-level, and one patient with multilevel TSS and hypophosphatemic rickets who underwent surgery due to TSS, were retrospectively evaluated using the discharge summary, surgical reports, and preoperative and postoperative radiological images.Results: The age of the patients ranged from 53 to 68 years. Of the patients included in the study, one underwent hemilaminectomy, two underwent total laminectomy, six underwent laminoplasty, and five underwent total laminectomy with fusion and posterior instrumentation. A dramatic improvement was observed in the neurological deficits existing in the preoperative period in patients who were diagnosed in the early period and underwent surgery with adequate decompression before the development of severe neurological deficits and who continued postoperative rehabilitation added to the treatment.Conclusion: Patients with TSS have an insidious clinical course manifested by upper motor neuron symptoms. Although the prevalence of TSS is low, early diagnosis and treatment are important. The results of surgery are satisfactory when adequate decompression is achieved before the clinical condition worsens.