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Öğe Avulsion Fracture of the Anterior Iliac Crest after Bone Graft Harvest: Case Report and Review of Techniques, Risk Factors and Treatment(Turkish Neurosurgical Soc, 2011) Ovalioglu, Aysegul Ozdemir; Kilincer, Cumhur; Ovalioglu, Talat Cem; Simsek, OsmanThe anterior iliac crest is the harvest site preferred by many surgeons because of the quantity and quality of bone obtainable and the simplicity of harvesting techniques. Avulsion fracture of the iliac crest following bone grafting is an extremely rare occurrence. We present a case report of avulsion fracture of the anterior iliac crest following bone graft harvesting for anterior cervical fusion in a 63-year-old man. Non-operative treatment was the method of our treatment in the patient. By means of the presented case, iliac crest bone grafting techniques, risk factors of avulsion fracture, and treatment options were reviewed.Öğe Barotrauma during apnea testing for brain death. Barotrauma and apnea testing(Reial Acad Medicina Illes Balears, 2022) Inal, Mehmet Turan; Memis, Dilek; Ceritoglu, Ece Burcak; Karakas, Hilal; Simsek, Osman; Yanik, FazliThe apnea test is used for the diagnosis of brain death. Various complications have been reported to have developed during the apnea test. A 44-year-old woman was hospitalized in the intensive care unit due to unconsciousness due to a posterior inferior carotid artery aneurysm. On the forty-ninth day of her hospitalization in the intensive care unit, the patient had no motor response and all brain stem reflexes were negative. Brain death was considered in the patient, but subcutaneous emphysema and bilateral pneumothorax developed within minutes during the apnea test. The patient underwent bilateral tube thoracostomy. The patient could not be diagnosed with brain death and died on the fiftieth day of her hospitalization. This report emphasizes that multiple complications can be observed during the apnea test and underlying mechanisms and therapeutic approaches are discussed.Öğe Comparison of regression tree data mining methods for prediction of mortality in head injury(Pergamon-Elsevier Science Ltd, 2011) Sut, Necdet; Simsek, OsmanWith this research, we sought to examine the performance of six different regression tree data mining methods to predict mortality in head injury. Using a data set consisting of 1603 head injury cases, we assessed the performance of: the Classification and Regression Trees (CART) method; the Chi-squared Automatic Interaction Detector (CHAID) method; the Exhaustive CHAID (E-CHAID) method; the Quick, Unbiased, Efficient Statistical Tree (QUEST) method; the Random Forest Regression and Classification (RFRC) method; and the Boosted Tree Classifiers and Regression (BTCR) method, in each case based on sensitivity, specificity, positive/negative predictive, and accuracy rates. Next, we compared their areas under the (Receiver Operating Characteristic) ROC curves. Finally, we examined whether they could be grouped in meaningful clusters with hierarchical cluster analysis. Areas under the ROC curves of regression tree data mining methods ranged from 0.801 to 0.954 (p < 0.001 for all). In predicting mortality in head injury under the ROC curve, the BTCR method achieved both the highest area (0.954) and accuracy rate (93.0%), while the CART method achieved both the lowest area (0.801) and accuracy rate (91.1%). All of the regression tree data mining methods were clustered in the same grouping, but the BTCR method was at the origin of the cluster while the CART and QUEST methods produced results that were least like the others. The BTCR, demonstrating a 93.0% accuracy rate and showing statistically significantly differences from the others, may be a helpful tool in medical decision-making for predicting mortality in head injury. (C) 2011 Elsevier Ltd. All rights reserved.Öğe Development of a comprehensive and clinically applicable novel projection classification system for anterior communicating artery aneurysms(Springer, 2024) Orakdogen, Metin; Mammadkhanli, Orkhan; Chousein, Baris; Simsek, OsmanVarious surgical and anatomical classifications have been proposed to date related to ACoA aneurysm projection. Nonetheless, a universally accepted classification system is yet to be established. This study is aimed at establishing a standardized classification system for ACoA aneurysms with utilization 3D technology and defining reference lines for their projections. The goal is to create a simple, understandable, surgically beneficial, and reliable classification system based on neurovascular structures in the region, including safe and hazardous zones. The radiologic data of 96 patients with ACoA aneurysm who were treated in our university hospital between 2012 and 2020 were retrospectively analyzed, and a planned classification scale was developed with the data obtained. The classification aimed to create 9 main projection groups in the sagittal plane: superior, inferior, anterior, and posterior in linear orientation, and anterosuperior, posterosuperior, anteroinferior, posteroinferior, and complex in quadrant orientation. The coronal and axial planes included medial, lateral, and midline classifications, resulting in a 3-dimensional classification system with 25 projections. Among the 96 patients, 32 had linear and 64 had quadrant projections. In the sagittal plane, the linear projection breakdown was as follows: superior (28%), inferior (6.25%), anterior (53%), and posterior (12.5%). For the quadrant projection, the distribution was as follows: anterosuperior (53%), posterosuperior (12.5%), anteroinferior (21.87%), posteroinferior (3.12%), and complex (9.37%). Overall, 35.4% aneurysms were anterosuperior, 17.7% anterior, 14.58% anteroinferior, 9.37% superior, 8.3% posterosuperior, 6.25% complex, 4.16% posterior, 2.08% posteroinferior, and 2.08% inferior projection. Our study proposes a projection classification that utilizes 3D technology for safe surgery based on neurovascular structures in the region and thus better reveals safe and hazardous zones, including three plans, three dimensions, and two orientations. The use of this classification system offers valuable guidance for daily practice in the treatment of ACoA aneurysms.Öğe Effective factors in the outcome of head injury(Turkish Assoc Trauma Emergency Surgery, 2012) Akyel, Serkan; Simsek, Osman; Sut, NecdetBACKGROUND In this study, the data that could be obtained from our patient record system were investigated with respect to factors affecting the outcome in adult patients with head injury. METHODS The records of 356 adult head-injury patients (308 males, 48 females; mean age 43.1 +/- 18.6 years; range 17 to 87 years) hospitalized in Trakya University Hospital, Department of Neurosurgery and the Intensive Care Unit were examined. Results of the obtained data were analyzed statistically. RESULTS Age (p=0.012), use of airway tube (p<0.001), Glasgow Coma Scale values determined at the injury site and in the Emergency Unit (p<0.001), clustered systolic and diastolic tricuspid annulus values (p<0.001), accompanying chest (p=0.001) and abdominal (p=0.041) injury, anisocoria (p=0.001), pupillary light response (p<0.001), intracranial radiologic findings such as subdural hematoma (p<0.001), brain contusion (p=0.006), traumatic subarachnoid hemorrhage (p<0.001), traumatic intracranial hemorrhage (p=0.005), and brain edema (p<0.001), performance of a surgical procedure (p<0.001), and presence of nosocomial infection (p<0.001) were demonstrated to cause significant differences in the outcome. CONCLUSION The main aim must be to reduce accidents in an effort to reduce the number of deaths due to head injuries; additionally, emergency and hospital care facilities should be developed with respect to head injury cases.Öğe The effects of the early and ultra-early intervention on the outcome in aneurysmatic subarachnoid hemorrhage(Turkish Assoc Trauma Emergency Surgery, 2021) Akinci, Ahmet Tolgay; Akturk, Yener; Tutunculer, Banu; Orakdogen, Metin; Simsek, OsmanBACKGROUND: The optimal timing of intervention for aneurysmatic subarachnoid hemorrhage is one of the historically controversial issues in neurosurgery. Although numerous studies investigated the subject, they had many limitations due to the nature of the disease. Early and ultra-early interventions have gained more and more supporters in recent decades. Nevertheless, the effects of the early and ultra-early intervention on the outcome of the disease are far from clarity. METHODS: A single-center retrospective cohort study was carried out at Trakya University Medical Faculty Training and Practice Hospital. The study includes data on all patients admitted with an aneurysmal subarachnoid hemorrhage between January 1, 2001, and December 31, 2005. Patients were divided into two groups according to their WFNS grade status: Good (I-III) or poor (IV-V) grades. Patients are also classified according to their Glasgow Outcome Scale score: Unfavorable (1-2) or favorable (3-5) outcomes. Data were analyzed statistically, and the effects of the early and ultra-early intervention on the outcome were assessed. RESULTS: A total of 580 patients were admitted in the study period. Among them, 494 were eligible for the study. The median age (interquartile range) was 55 (18) years. While 244 (49.4%) patients were women, 250 (50.6%) patients were men. Three hundred and fourteen (63.6%) patients were operated, and 25 patients (5.1%) were undergone endovascular treatment. The ultra-early intervention was achieved in 60 (12.1%) patients and 142 patients (28.7%, including the previous ultra-early intervention group) early intervention was achieved. A meaningful outcome difference was present between the poor-grade ultra-early treatment group and the rest (p=0.007). Analogously, a meaningful outcome difference was present between the poor-grade early treatment group and the rest (p<0.001). CONCLUSION: This study supports the growing trend toward early or ultra-early intervention in aneurysmatic subarachnoid hemorrhage. Our findings showed that both early and ultra-early interventions have positive effects on the outcome in poor-grade aneurysmatic subarachnoid hemorrhage patients. Future studies with more homogenized and larger samples should be realized to clarify the optimal timing of intervention for aneurysmatic subarachnoid hemorrhage.Öğe THE EFFECTS OF ULTRA-EARLY CLIPPING ON SURVIVAL AND NEUROLOGICAL OUTCOME IN POOR-GRADE ANEURYSMAL SUBARACHNOID HAEMORRHAGE(Literatura Medica, 2022) Simsek, Osman; Akinci, Ahmet TolgayBackground and purpose - European Stroke Organisation guidelines advise treating aneurysmal subarachnoid haemorrhage (aSAH) as early as possible. However, the optimum timing along with its beneficial effects is controversial. Therefore, we aimed to investigate the effects of ultra-early clipping on neurological outcomes and survival in poor-grade aneurysmal subarachnoid haemorrhages. Methods - This retrospective study included all poorgrade aneurysmal subarachnoid haemorrhage patients treated by ultra-early surgical clipping at Trakya University Hospital between January 1, 2001, and December 31, 2020. We analysed the outcome and mortality data of these patients. Specifically, we evaluated the effects of ultra- early clipping on outcomes, defined as within six hours of the onset of symptoms. Results - From 813 records, 212 met our inclusion criteria. Of these, 117 (55.2%) were female and 95 (44.8%) male. The mean age was 58.3 +/- 13.7 years. Glasgow Outcome Scale scores differed significantly between age groups, subarachnoid haemorrhage grades, those who did and did not rebleed, and those who did or did not suffer from vasospasms. A beneficiary relationship was found between ultra-early clipping and mortality among patients. Furthermore, favourable outcomes were significantly more frequent in the ultra-early clipping group. Conclusion - The aSAH patients treated at our hospital who received ultra-early clipping had significantly lower mortality rates and more favourable outcomes. The difference was significant among those treated during the last decade and among patients younger than 50.Öğe Hemangiopericytoma at the Craniovertebral Junction: A Case Report(Kare Publ, 2019) Delen, Emre; Akinci, Ahmet Tolgay; Turkkan, Gorkem; Yalta, Tulin Deniz; Simsek, OsmanIntradural extra medullary hemangiopericytomas (HPCs) are extremely rare and a hemangiopericytoma located at the craniovertebral junction might present radiologic features similar to those of meningioma or schwannoma.To the best of our knowledge, this report is among a few reported cases of HPC at the craniovertebral junction. Although they are very rare, HPCs should kept in mind in the differential diagnosis of the intradural extramedullary lesion due to differences in treatment such as adjuvant radiotherapy.Öğe Infection in patients with isolated head injury: risk factors and the impact on treatment cost(Turkish Assoc Trauma Emergency Surgery, 2012) Arslan, Alp; Birgili, Baris; Akinci, Ahmet Tolgay; Simsek, Osman; Kilincer, CumhurBACKGROUND We aimed to determine risk factors and the impact on treatment cost of infection in patients with isolated head injury. METHODS Data acquired from 299 patients (239 males, 60 females; mean age 35,1 +/- 23,2 years) with isolated head trauma who were hospitalized for more than 72 hours at Trakya University Training and Research Hospital between 2001-2007 Were evaluated retrospectively. Data including age, gender, initial neurological examination, radiological findings, duration of hospitalization, need for surgery, cost of infection treatment, total cost of care, and outcome scores were determined. Two groups divided according to the development of infection were compared for risk factors and the impact of infection on the cost of treatment. RESULTS In the group of patients with infection, the mean Glasgow Coma Scale score at delivery was lower; anisocoria, light reflex loss, lateralized deficit, skull base fracture, subdural hematoma, and cerebral edema findings were more frequent. A four-times longer hospital stay, 10-times higher total cost and a significantly increased mortality rate were determined in this group. For the patients with light head injury, in the group of patients with infection, the mean age was found to be higher. CONCLUSION For patients with isolated head injury, there are some risk factors for the development of infection that increase the hospitalization duration, total cost of care and mortality rates.Öğe Internal Validation of Two Models Developed for Prognostication of Patients with Isolated Traumatic Brain Injury(Turkish Neurosurgical Soc, 2023) Akinci, Ahmet Tolgay; Simsek, Osman; Kocaturk, MuratAIM: To evaluate the efficiency of two models for prognostication of patients with isolated traumatic brain injury.MATERIAL and METHODS: The models developed with the data of the patients who applied within ten years were subjected to internal validation with the data of the patients who applied within the following five years. The records of 204 patients with traumatic brain injury admitted into Neurosurgery Department and Intensive Care Units were reviewed. Models were applied to procure estimates of prognosis. The estimates were statistically compared with the actual clinical outcome of patients using discriminant analysis.RESULTS: For Model 1, the correct classification rate was calculated as 87.9%, the specificity as 66.7%, the sensitivity as 94.2%, the positive predictive value as 68.8%, and the negative predictive value as 93.6%. For Model 2 the correct classification rate was evaluated as 90.2%, the specificity as 57.6%, the sensitivity as 96.5%, the positive predictive value as 76%, and the negative predictive value as 92.2%.CONCLUSION: Both of the models had decent correct classification rates and may be efficient estimation tools for the prognostication of unfavourable outcome in patients with isolated traumatic brain injury. These models are good candidates to be used widely following the evaluation of their validity with national and international multicentric studies.Öğe Modified 30-Degree Head-Up Tilt Park Bench Position in Semielective Posterior Fossa Surgery in a Patient with Pheochromocytoma(Georg Thieme Verlag Kg, 2023) Sahin, Sevtap Hekimoglu; Simsek, Osman; Akinci, Tolgay; Cakici, ZaferVon Hippel-Lindau (VHL) disease is a rare genetic disorder associated with the central nervous system and visceral organs. Pheochromocytomas occur in 10% of VHL patients, while cerebellar tumors are common tumors in VHL syndrome, with an incidence of 60%. The most common position for posterior fossa operations is the park bench or lateral decubitus position. These positions have primarily replaced the sitting position. However, the advantages of the supine position cannot be overlooked. The coexistence of pheochromocytoma and the cerebellar tumor may require modification in surgical position and anesthesia management in line with possible pathophysiological changes. We present the anesthesia management in posterior fossa surgery in patients with postponed pheochromocytoma surgery. The present case highlights the importance of a multidisciplinary team approach and anesthetic management.Öğe Nocardial brain abscess: Review of clinical management(Elsevier Sci Ltd, 2006) Kilincer, Cumhur; Hamamcioglu, M. Kemal; Simsek, Osman; Hicdonmez, Tufan; Aydoslu, Bayram; Tansel, Ozlem; Tiryaki, MehmetNocardiosis has become a significant opportunistic infection over the last two decades as the number of immunocompromised individuals has grown worldwide. We present two patients with nocardial brain abscess. The first patient was a 39-year-old woman with systemic lupus erythematosus. A left temporoparietal abscess was detected and aspirated through a burr-hole. Nocardia farcinica infection was diagnosed. The patient had an accompanying pulmonary infection and was thus treated with imipenem and amikacine for 3 weeks. She received oral minocycline for 1 year. The second patient was a 43-year-old man who was being treated with corticosteroids for glomerulonephritis. He was diagnosed with a ring-enhancing multiloculated abscess in the left cerebellar hemisphere, with an additional two small supratentorial lesions and triventricular hydrocephalus. Gross total excision of the cerebellar abscess was performed via a left suboccipital craniectomy. Culture revealed Nocardia asteroides, and the patient was successfully treated with intravenous ceftriaxone, then oral trimethoprime-sulfamethoxazole for 1 year. The clinical course, radiological findings, and management of nocardial brain abscess are discussed in light of the relevant literature, and current clinical management is reviewed through examination of the cases presented here. (C) 2006 Elsevier Ltd. All rights reserved.Öğe Optimizing surgical approaches for anterior communicating artery aneurysms: Development and internal validation of a novel surgical scoring system(Springer, 2024) Orakdogen, Metin; Mammadkhanli, Orkhan; Simsek, OsmanBackgroundThe objective was to provide comprehensive preoperative information on both the aneurysm orientation and the side and method of surgical approach for optimal preoperative information and safe clipping using 3D imaging modalities. This was achieved by making an objective risk assessment on the surgical side/method and evaluating its effectiveness with internal validation.Materials and methodsRadiologic data of 61 ACoA aneurysm patients between 2012 and 2020 were retrospectively analyzed. A scoring system based on five criteria; ACoA aneurysm dome orientation, A1 symmetry/control, perforating artery control, A2 trace orientation, and A2 fork symmetry was developed. The system is designed to align with the most common surgical approaches in ACoA aneurysm surgery. The patients were categorized into three groups based on the scoring results to determine the most appropriate surgical method. Group I was recommended, Group II was less recommended, and Group III was least recommended. Internal validation was performed to assess the system's effectiveness. Outcomes and complication rates were statistically evaluated.ResultsWhen the scoring system was utilized, the mean score difference between the first group and the other groups was 2.71 and 4.62, respectively. There was a homogeneous distribution among the groups in terms of age, sex, WFNS, and Fisher scores. Complication occurred in three patients in Group I and nine patients each in Group II and Group III. The further the deviation from the first option, the higher the complication rate (p = 0.016), and a significant cause-effect relationship was identified (p = 0.021). The ROC curve established a cut-off value of 12.5 points for complications and outcomes.ConclusionOur study introduces a new scoring system for ACoA aneurysms, enhancing the use of 3D CTA in daily practice and providing internal validation for the proposed approach. By evaluating objective criteria, this scoring system helps predict surgical risks, prevent complications, and supports personalized evaluation and selection of the surgical approach based on objective criteria.Öğe Predicting Prognosis of Isolated Head Injury: A Computer-Based Model with Simple Variables(Galenos Publ House, 2011) Simsek, Osman; Sut, Necdet; Kilincer, Cumhur; Hamamcioglu, Mustafa Kemal; Memis, DilekObjective: Over one hundred predictive models were defined in the past for head injury (HI) prognosis, but none of them have been widely used up to the present. The aim of this study is to predict the prognosis of isolated HI patients by simply using data from the first day after injury. Materials and Methods: Data of head injury patients in Trakya University Hospital between January 1996 and December 2006 were obtained from records. The age, gender, causes of HI, basic neurologic examination findings, radiologic findings and discharge status are examined. Results: Most of the data were simplified as absent (0) and present (1), and mortality rates for each groups were accepted weighted values. All data were processed statistically and two models were created. Model 1 with Glasgow Coma Scale (GCS) score predicted the mortality/vegetative event at a rate of 56.5%, and the conscious survival event at 98.7%. Model 2, without the GCS score, predicted the mortality/vegetative event at 55.1% rate and the conscious survival event at 99.2%. Conclusion: Both models could be used for informing the patient and relatives and helping them to understand the severity of HI in busy working conditions of emergency departments.Öğe Spontaneous spinal epidural hematoma after seizure(Sage Publications Inc, 2007) Guzel, Ahmet; Simsek, Osman; Karasalihoglu, Serap; Kuecuekugurluoglu, Yasemin; Acunas, Betuel; Tosun, Alptekin; Cakir, Bilge[Abstract Not Available]Öğe Spontaneous subarachnoid haemorrhage incidence among hospitalised patients in Edirne, Turkey(Springer Wien, 2019) Simsek, Osman; Akinci, Ahmet Tolgay; Delen, Emre; Sut, NecdetBackground To the best of our knowledge, no data has been published about the spontaneous subarachnoid haemorrhage (sSAH) incidence in Turkey. We aimed to report the estimation of sSAH incidence in Edirne Province, in Turkey for the first time, using the data acquired from a single medical centre which has the biggest and the most comprehensive emergency department in Edirne and to where a great majority of patients are referred. Methods We investigated all the accessible sSAH patients' data obtained from computer-based automation systems and all the written documents in the neurosurgery and the emergency departments. Patients included in the study were diagnosed with sSAH between the dates of January 2007 and December 2011 and were resident in Edirne. We used this data to calculate the crude and age-adjusted incidence rates of sSAH for every decade. Results One hundred fifty-four patients have been diagnosed with sSAH during a 5-year period. Among them, 72 were men (47.8%) and 82 (53.2%) were women. The mean age of the patients was 60.8 years and age range was 23-85 years. The overall annual adjusted incidence rate for sSAH was 10.3 per 100,000 person-years (95% confidence interval = 10.2-10.3). Annual adjusted incidence rate was 10 per 100,000 person-years (95% confidence interval = 10-10.1) for men. For women, it was 10.4 per 100,000 person-years (95% confidence interval = 10.4-10.5). For both sexes, after the 6th decade, the annual incidence rate of sSAH was higher than 10 per 100,000, reaching over 20 per 100,000 person-years after the 7th decade. The overall crude incidence rate for sSAH was 10.3 per 100,000 person-years. For men, the crude incidence rate was 9.4 per 100,000 person-years and for women, it was 11.2 per 100,000 person-years. Conclusions This study showing the first sSAH incidence estimation in Edirne might also be accepted as an estimation of overall epidemiological sSAH aspect in Turkey. Future investigations should be realised in different parts of Turkey to enlighten the epidemiological state of affairs and the course of sSAH in Turkey.
