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Öğe 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, KadirIntroduction ?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.Öğe Outcomes of Microsurgical Clipping in Middle Cerebral Artery Aneurysms(Ordu Üniversitesi, 2021) Seçer, Mehmet; Gökbel, AykutObjective: 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.Öğe Results of Microvascular Decompression Surgery in the Treatment of Trigeminal Neuralgia(2021) Seçer, Mehmet; Gökbel, AykutINTRODUCTION: 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.Öğe Sakrum Kırıkları ve Spinopelvik İnstabilite(2020) Özkal, Birol; Seçer, MehmetSakrum, biyomekanik olarak, vücudun kuvvet bileşenlerinin merkezinde yer alan spinal kolondan pelvise yük transferi yapankemik bir yapıdır. Omurgadaki eksenel kuvvet, sakroiliak eklemin önünde yer alır ve ikinci sakral vertebrada merkezileşmiş önedoğru bir dönüş kuvveti oluşturur. Sakrumda kırık oluşturabilacak kadar şiddetli travmalar, vücudun diğer yerlerinde de sıklıklaciddi yaralanmalara yol açabildiklerinden tanı gözden kaçabilmekte, hastaların gerekli tedaviyi almaları gecikebilmektedir. Her hastaiçin ayrı bir tedavi planı oluşturulmak gerekse de hastanın stabil mi instabil mi olduğunun ayırt edilmesi önemlidir. Sakrum kırığıtedavisinde çeşitli konservatif ve cerrahi tedavi seçenekleri bulunmaktadır. Biz burada sakrum kırığına dikkat çekerek hastaların tanıve tedavi yöntemlerini literatür eşliğinde tartışmayı amaçladık.Öğe Servikal Spinal Dejeneratif Hastalıkların Cerrahisinde İntraoperatif Görüntüleme Teknikleri ve Önemi(2022) Şahin, Balkan; Coşkun, Mehmet Erdal; Tureyen, Kudret; Seçer, MehmetToplumun yaşam süresinin artması ve yaşlanmasının doğal bir sonuç olarak ise servikal dejeneratif hastalıklar, spinal cerrahi pratiğinde sık karşılaşılan patolojilerdir. Bu patolojilere cerrahi yaklaşım esnasında intraoperatif görüntüleme, cerrahi tekniğin doğru uygulanabilmesi ve cerrahinin başarı açısından son derece önemlidir. Servikal spinal dejeneratif hastalıkların cerrahisinde intraoperatif görüntüleme cerrahi başarı için mutlaka kullanılmalıdır. Tüm spinal yaklaşımlarda olduğu gibi servikal omurga cerrahisi sırasında da servikal omurganın radyografik olarak görüntülenmesi esastır ve omurga cerrahları tarafından önerilmekte, rutin olarak kullanılmaktadır. Bu ameliyatlarda cerrahi bilgi ve tecrübenin, cerrahinin başarısına aktarılabilmesi ve güvenli bir cerrahi yapılabilmesi için elzemdir. Bu amaçla C - Kollu Floroskopi, O –arm / O –arm tabanlı navigasyon sistemleri, BT Navigasyon Eşliğinde Robotik Cerrahi, İntraoperatif Nörofizyolojik Monitörizasyon kullanılan intraoperatif görüntüleme yöntemleridir.Öğe Surgical management and its outcomes in distal anterior cerebral artery aneurysms(2021) Seçer, Mehmet; Gökbel, AykutThe 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.Öğe Surgical Management of the Hangman’s Fracture in the Twelve Cases: Case Series(2023) Akşan, Özgür; Seçer, MehmetObjective: Hangman's fracture is a condition characterized by anterior displacement of C2 upon C3 with a fracture in the C2 where the neural arch attaches to the vertebral corpus as a result of axial loading of the head accompanying hyperextension. Material and Methods: From January 2015 to January 2022, analysis retrospectively included 12 patients operated by hangman’s fracture. The lesions were considered to be a hangman’s fracture after computed tomography findings. The clinical condition was classified on the basis of American Spinal Injury Association scale and visual analog scale. All patients underwent C2-3 posterior fusion. All patients had at 6 and 12 months follow-up cervical computed tomography, which were used to assess bony union, final displacement, and angulation. Results: 5 of the patients were males and 7 females with the age range of 22-82 (mean age 49). The cause of trauma was in vehicle accident in 4 patients, falling from a height in 6 patients, and falling after slipping in the bathroom in 2 patient. All patients complained of neck pain. Except for 2 patients with upper extremity paralysis and spastic tetraparesis, 10 patients had no neurological deficit. According to the Levine and Edwards typical hangman’s fracture classification, 7 had Type II fractures, while one patient had Type III fractures. According to the Li-Wang atypical hangman’s fracture classification, 4 were Type B. Conclusion: Radiological evaluation and subsequent classification are very important in management. Posterior C2-3 fusion is a very effective surgical way.Öğe The Effect of Ligamentotaxis on Clinical and Radiological Outcomes in Thoracolumbar Burst Fractures with High McCormack Grade(2023) Seçer, Mehmet; Gürbüz, Hande; Gülcü, AnılThe aim of this study was to investigate the effect of ligamentotaxis performed in combination with the posterior surgical approach in thoracic and lumbar burst fractures due to high-energy trauma with high McCormack scores (?7). This observational study was conducted at the University of Health Sciences from January 2015 to December 2020. Medical records of 16 patients were retrospectively evaluated. The vertebral height measurements, local kyphosis angles, and anteroposterior spinal canal diameter were measured pre- and postoperatively. American Spinal Injury Association (ASIA), McCormack, and thoracolumbar injury classification and severity (TLICS) scores were also evaluated. All postoperative measurements showed a significant change. There was no statistical significance in the pre- and postoperative ASIA grades. No screw breakages were observed within a mean follow-up period of 35.50±11.79 months. Ligamentotaxis effectively increased the spinal canal diameter and provided vertebral height restoration and kyphosis angle correction in thoracolumbar burst fractures with a high McCormack score. However, no significant neurological improvement was observed in cases with neurological deficits, although laminectomy was performed with ligamentotaxis. © 2023 College of Physicians and Surgeons Pakistan. All rights reserved.Öğe Thoracic Spinal Stenosis: Surgical Approaches and Outcomes(Ordu Üniversitesi, 2021) Gökbel, Aykut; Seçer, Mehmet; Gokbel, TugbaObjective: 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.
