Biomedical subjects

Zeki Sekerci

Publications and source records attributed to Zeki Sekerci.

9 recordsLinked to original sources

PubMed2006

Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience.

We present the long-term clinical and angiographic follow-up results of 100 consecutive intracranial aneurysms treated with Onyx liquid embolic system (MTI, Irvine, Calif.), either alone or combined with an adjunctive stent, in a single center. A total of 100 aneurysms in 94 patients were treated with endosaccular Onyx packing. Intracranial stenting was used adjunctively in 25 aneurysms including 19 during initial treatment and 6 during retreatment. All aneurysms except two were located in the internal carotid artery. Of the 100 aneurysms, 35 were giant or large/wide-necked, and 65 were small. Follow-up angiography was performed in all 91 surviving patients (96 aneurysms) at 3 and/or 6 months. Follow-up angiography was performed at 1, 2, 3, 4 and 5 years in 90, 41, 26, 6 and 2 patients, respectively. Overall, aneurysm recanalization was observed in 12 of 96 aneurysms with follow-up angiography (12.5%). All 12 were large or giant aneurysms, resulting in a 36% recanalization rate in the large and giant aneurysm group. One aneurysm out of 25 treated with the combination of a stent and Onyx showed recanalization. There was also no recanalization in the follow-up of small internal carotid artery aneurysms treated with balloon assistance only. At final follow-up, procedure- or device-related permanent neurological morbidity was present in eight patients (8.3%). There were two procedure-related and one disease-related (subarachnoid hemorrhage) deaths (mortality 3.2%). Delayed spontaneous asymptomatic occlusion of the parent vessel occurred in two patients, detected on routine follow-up. Onyx provides durable aneurysm occlusion with parent artery reconstruction resulting in perfectly stable 1-year to 5-year follow-up angiography both in small aneurysms treated with balloon assistance only (0% recanalization rate) and large or giant aneurysms treated with stent and Onyx combination (4% recanalization rate). Endosaccular Onyx packing with balloon assistance may not be adequate for stable long-term results in those with a large or giant aneurysm. However, the recanalization rate of 36% in these aneurysms is better than the reported results with other techniques, i.e., coils with or without adjunctive bare stents.

Adolescent↗

PubMed2006

Cervical foraminal area and intervertebral height changes after titanium ring cage placement: preliminary results.

OBJECTIVE: To investigate the effect of titanium ring cage implantation on cervical foraminal area and intervertebral height. METHODS: Twenty-two patients with single level cervical disc herniation were enrolled in this study. All patients underwent a standard anterior cervical discectomy followed by titanium ring cage implantation. Radiographs were used for evaluation of the cervical foraminal area and intervertebral height in the pre- and postoperative periods. RESULTS: Mean intervertebral heights were 0.7 +/- 0.1 cm (preoperative), 1.1 +/- 0.2 cm (early postoperative) and 0.9 +/- 0.2 (final measurement). Increase in intervertebral height at final follow-up was 0.2+/-0.1 cm (22.6+/-8.5%). Mean cervical foraminal areas were 0.4+/-0.1 cm2 (preoperative), 0.5 +/- 0.2 cm2 (early postoperative) and 0.5 +/- 0.1 cm2 (final measurement). Increase in cervical foraminal area at the final follow-up was 0.1 +/- 0.1 cm2. CONCLUSION: Our study demonstrates that cervical intervertebral height and cervical foraminal area significantly increased after cervical ring cage placement but subsidence during the follow-up period negatively affects foraminal area. However, overall, there was a relative increase of foraminal area and intervertebral height when compared with preoperative values. Long-term follow-up is required to further assess the subsidence rate.

Adult↗

PubMed2006

Computer-assisted intraaneurysmal thrombus visualization.

OBJECTIVE: Improved visualization of intraaneurysmal thrombi can contribute to understanding their impact on clinical courses and treatments. Digital subtraction angiography (DSA) demonstrates the hemodynamic portion of aneurysm domes and vasculature structures and has been considered by many to be the principal technique used for aneurysm diagnosis. An intraaneurysmal thrombus may be visualized as a filling defect on DSA, but DSA does not reliably indicate the presence of an intraaneurysmal thrombus or its details. Computerized tomography (CT) and magnetic resonance (MR) imaging may have advantages over DSA, particularly because of their capacity to visualize soft tissue. Hence, we investigated the reconstruction of MR and CT images and compared it to DSA for assessment of intraaneurysmal thrombi. METHODS: Thirty-one patients with 34 aneurysms were enrolled. The entire group was examined with DSA. Sixteen cases were also examined with MR imaging; the remaining 15 were examined with CT imaging. Images of intraaneurysmal thrombi were rendered from corresponding MRI and soft tissue scans using CT. Intracranial vessels and aneurysms were defined from MR and CT angiography. Whole images were linked via imaging software for the reconstruction of vasculature structures. Images were superimposed to produce visualizations of thrombi situated in aneurysmal bodies. RESULTS: Reconstruction of the MR and CT images clearly demonstrated the presence and details of intraaneurysmal thrombi in 9 (26.4 %) of 34 aneurysms. DSA detected only 4 (11.7 %) of the cases as a filling defect. Significant differences in thrombus visualization were observed between DSA used alone or in conjunction with either MRA (P = .02) or CTA (P = .04) images. Mean volume of thrombosed aneurysms was 3.2 +/- 0.84 mL (mean +/- SEM) and thrombosis volume was 0.9 +/- 0.31 mL. Aneurysm and nested thrombus volumes were highly correlated (r = 0.987; P < .001). CONCLUSION: Intraaneurysmal thrombi were clearly visualized by computerized MR and CT image reconstruction. MR and CT were superior to DSA alone in demonstrating the presence of intra-aneurysmal thrombi. Computer-assisted 3-D visualization can be invaluable in understanding the shape and volume of intraaneurysmal thrombi, which may contribute to more accurate assessment and effective treatment of aneurysms cases.

Adult↗

PubMed2006

Early changes in the cervical foraminal area after anterior interbody fusion with polyetheretherketone (PEEK) cage containing synthetic bone particulate: a prospective study of 20 cases.

OBJECTIVES: Although the use of intervertebral fusion after anterior cervical microdiscectomy remains controversial, a new surgical device is proposed for use in intervertebral fusion instead of bone graft. The authors evaluate the effects of implantation of polyetheretherketone (PEEK) cage containing synthetic bone particulate on the height and cross-sectional area of the foramen, the intervertebral disk height and the degree of lordosis. METHODS: Twenty consecutive patients with radiculopathy owing to cervical disk herniation were scheduled. They underwent multislice computed tomographic scanning pre-operatively and 1 day post-operatively. RESULTS: Pre-operatively, the mean height of the right foramina was 8.807 +/- 1.120 mm, the left foramina was 9.500 +/- 1.529 mm. Post-operatively, the mean foraminal height of the right side was 11.080 +/- 1.121 mm and 10.020 +/- 1.453 mm on the left. This difference reached statistical significance on the right foraminal height (p=0.000) but not on the left side (p=0.078). The mean area of the right foramina was 46.82 +/- 14.54 mm(2) and 52.71 +/- 15.62 mm(2) on the left side pre-operatively. Post-operatively, the values were 60.87 +/- 15.91 mm(2) and 55.83 +/- 13.88 mm(2) respectively. In terms of pre-operative value, the 1 day post-operative measurement reached again statistical significance (p=0.002) on the right side. The mean value of disk height was 3.653 +/- 0.596 mm pre-operatively and 6.387 +/- 0.533 mm at 1 day post-operatively. This difference is statistically significant (p=0.000). DISCUSSION: Implantation of a PEEK cage containing synthetic bone particulate in the treatment of cervical disk disease offers good immediate stabilization by easier implantation technique and avoids donor site morbidity. It provides an increase in height and cross-sectional area of the neural foramina. These preliminary results suggest that interbody fusion cages appear to be safe and effective.

Adult↗

PubMed2005

Peritumoral brain edema in intracranial meningiomas.

OBJECTIVE: The goal of this study was to determine the relationship between patient age and gender and meningioma location, histological subtype, size, lobulation and peritumoral brain edema (PTBE). PATIENTS AND METHODS: In a series of 55 patients with intracranial meningiomas, factors possibly related to the development of PTBE were analyzed. We used an EI (edema index) as the indicator of PTBE. EI was calculated by dividing the area of PTBE by that of the tumor. Thus if EI = 1, there is no PTBE. Univariate analysis was used to evaluate the relationship between EI and related factors. The MEI (mean edema index) difference between age groups was calculated using the Duncan Test. RESULTS: We found that none of the factors analyzed influenced PTBE except patient age 61-70 years, which correlated with PTBE (p = 0.022). The difference between MEI in the 41-50 years and 61-70 years age groups was significant, with that in the 61-70 years age group being significantly higher. CONCLUSION: We conclude that these findings in the 61-70 years age group may constitute an increased risk of perioperative mortality and morbidity.

Adult↗

PubMed2005

Bilateral reversible deafness after surgery for unilateral epidermoid tumor: an unusual complication: case report.

OBJECTIVE AND IMPORTANCE: We present an unusual complication of bilateral hearing loss after surgery for unilateral epidermoid tumor situated at the right pontocerebellar junction. The neurosurgeon must know the possible causes of this catastrophic complication and should take every possible measure to avoid it. CLINICAL PRESENTATION: A 43-year-old male patient presented with progressive hearing loss in the right ear. A radiological examination demonstrated a mass lesion at the right pontocerebellar junction. A pure tone audiogram revealed sensorineural hearing impairment of the right ear. A brainstem auditory evoked potential test confirmed this with reduced amplitudes and a prolonged I-V interval. INTERVENTION: The patient was operated on via a right paramedian suboccipital craniectomy. The tumor was completely excised, and all of the cranial nerves were preserved during the operation. Postoperatively, the patient developed total bilateral hearing loss, which improved significantly over time. CONCLUSION: Controlled cerebrospinal fluid drainage during exposure and tumor excision may reduce the possibility of shift and traction on the neural structures and help to prevent ischemic injury. Frequent irrigation of the surgical field and minimizing the spilling of the tumor contents may reduce the risk of chemical irritation. The use of corticosteroids may also help during the postoperative period.

Adult↗

PubMed2005

Chiari type I malformation presenting as hemifacial spasm: case report.

OBJECTIVE AND IMPORTANCE: We report on a patient with a Chiari I malformation presenting with right hemifacial spasm. Clinicians should consider the downward displacement of the hindbrain as a rare cause of hemifacial spasm in Chiari I malformation. CLINICAL PRESENTATION: An 18-year-old man was admitted with right hemifacial spasm. The results of the neurological examination were normal except for the facial spasm. Magnetic resonance imaging demonstrated a Chiari I malformation without syringomyelia. After surgery, the hemifacial spasm completely resolved. INTERVENTION: Posterior fossa decompression, C1 laminectomy, and duraplasty were performed. CONCLUSION: The hemifacial spasm could be attributed to compression and/or traction of the facial nerve because of downward displacement of the hindbrain in Chiari I malformation. Compression and/or traction might create irritation of the facial nerve that causes hemifacial spasm. Resolution of the hemifacial spasm after posterior fossa decompression could explain the facial nerve irritation in Chiari I malformation. Clinicians should consider Chiari malformation as a cause of hemifacial spasm and posterior fossa decompression as a potential treatment.

Adolescent↗

PubMed2003

Traumatic carotid-cavernous fistula treated by combined transarterial and transvenous coil embolization and associated cavernous internal carotid artery dissection treated with stent placement. Case report.

The authors report on a case in which a carotid-cavernous fistula and an associated cavernous-carotid dissection developed in a 48-year-old man following a motor vehicle accident. The fistula was treated with coil embolization via a combined transarterial-transvenous approach. The dissected carotid artery segment was treated with a balloon-expandable stent, which restored normal caliber and hemispheric flow. There was no recurrence of the fistula and the postoperative wide patency of the carotid artery indicates that stent placement is an effective method of treating traumatic intracranial artery dissections.

Aortic Dissection↗

PubMedDate not supplied

Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results.

BACKGROUND AND PURPOSE: We present our preliminary experience, including mid-term angiographic and clinical follow-up results, with an alternative technique for the endovascular treatment of intracranial aneurysms in a series of patients. This new method, previously described in anecdotal case reports, consists of endovascular deployment of an artificial vessel graft (stent graft or covered stent) in the parent vessel to exclude the intracranial aneurysm sac from circulation. METHODS: Twenty-five internal carotid artery (ICA) aneurysms in 24 patients were successfully treated by using a Jostent coronary stent graft deployed in the parent artery across the aneurysm neck. All except four aneurysms were extradural, located in the petrous or cavernous portion of the ICA. The four intradural aneurysms were located in the carotico-ophthalmic region. Seventeen aneurysms in 16 patients occurred posttraumatically, secondary to motor vehicle accidents or surgical injury. RESULTS: Twenty-three aneurysms were immediately excluded from circulation after stent graft placement. In two aneurysms, a slow contrast material filling (endoleak) into the aneurysm cavity was observed immediately after treatment. One was thrombosed, as shown by late control angiography; in the other one, a second larger bare stent was used to appose the stent graft's distal end to the ICA wall, thus sealing the endoleak into the distal graft. No technical adverse event, including vessel dissection, vessel perforation, or thromboembolism, occurred with or without clinical consequence. No mortality or morbidity developed during or after the procedure, including the follow-up period. Two-year control angiography in one patient, 1.5-year control angiography in two patients, 1-year control angiography in six patients, and 6-month control angiography in 12 patients were performed, revealing reconstruction of the ICA with no aneurysm recanalization. All symptoms resolved after treatment in the patients who had initially presented with mass effect. CONCLUSION: Initial anatomic, clinical and mid-term follow-up results in this small series of patients are encouraging. This technique has been proved to have potential in the reconstructive treatment of intracranial aneurysms. Further research and development are needed to optimize the stent graft technology for the cerebrovascular system.

Adolescent↗