Hakan Hadi Kadioglu

Ventricular catheter placement (VCP) is a life-saving intervention frequently performed in emergency departments and intensive care units. The free hand technique is the most commonly used approach for placing catheters. This study demonstrates the anatomical and radiological relationship between catheters inserted through the most commonly used access points and the anatomical structures in their path. Moreover, we calculate the insertion angles and catheter lengths that should be specified during VCP. Six donated human heads, fixed in 10% formalin and injected with colored silicone dye, were used in this study. Ventricular catheters were inserted through Kocher’s, Paine’s, Keen’s, Frazier’s, and Dandy’s points under navigation. Dissection was performed from the skin to the inner wall of the ventricle while preserving the inserted catheters. The insertion angle and delivery length for each access point were measured both in the donated human heads and in 50 patients with hydrocephalus. In addition, magnetic resonance tractography was performed, and the relationship of each catheter with anatomical structures was presented as a three-dimensional model. Catheters inserted from Keen’s and Paine’s points pass through regions containing dense and crucial vascular structures. Catheters inserted from Keen’s, Paine’s, and Frazier’s points enter the cortex through eloquent areas. The catheter inserted from Keen’s point passes through the most diverse white matter pathway. Catheters inserted from Kocher’s and Dandy’s points pass through regions with less dense cortical vascular structures. Moreover, they pass through noneloquent cortical structures and fewer white matter tracts. This is the first anatomical dissection and tractography report describing the relationship between catheters introduced through the most common ventricular access sites and the anatomical structures along their path from the skin to the ventricle. Understanding the anatomical and radiological three-dimensionality of VCP will increase the safety of its applications.

Objective/Background: Pupil diameter varies across individuals, limiting its reliability in assessing cerebral pathologies, particularly in comatose patients following subarachnoid haemorrhage (SAH). The Dangerous Alarming Diameter Assessment (DADA) index, defined as the ratio of iris surface to pupil surface, may offer a more precise diagnostic tool. This study evaluates the efficacy of the DADA index compared to pupil diameter in predicting neurodegeneration in the Edinger–Westphal nucleus (EWN) and diagnosing brain death in an SAH model. Methods: Twenty-two rabbits were divided into Control (n = 5), Sham (n = 5), and Study (SAH, n = 12) groups. Pupil diameter and DADA index values were measured via spectral-domain optical coherence tomography (SD-OCT) in groups at post-intervention (0.75 cc serum physiologic injection for Sham, 0.75 cc autologous blood injection for Study). After one week, animals were sacrificed, and EWN degenerated neuron density was quantified using stereological methods. Data were analysed with Kruskal–Wallis and Mann–Whitney U tests, with correlations assessed for pupil diameter and DADA index against EWN neurodegeneration. Results: Pupil diameter assessment classified all 12 study group subjects as deceased, primarily due to fixed and dilated pupils. In contrast, the DADA index identified only 8 of these 12 subjects as deceased, with EWN degenerated neuron density exceeding 80%, while the remaining 4 subjects showed less than 80% neurodegeneration, indicating viability. Strong negative correlations were observed between pupil diameter (r = −0.972, p < 0.001) and DADA index (r = −0.977, p < 0.001) with EWN neurodegeneration. The DADA index demonstrated superior precision in distinguishing severe neurodegeneration, suggesting its potential as a criterion for brain death assessment. Conclusions: The DADA index provides a more accurate and nuanced evaluation of EWN neurodegeneration compared to pupil diameter, offering a promising diagnostic tool for brain death in SAH-induced comatose states, with potential implications for future brain transplantation diagnostics.

Tumors of the pineal region (TPRs) are rare neoplasms that are surgically challenging to resect. Conventional treatment strategies are available, but gamma knife radiosurgery (GKRS) is an alternative approach. This study presents a single-center experience with GKRS performed for TPR with and without histopathological diagnoses. The cases of 25 patients with TPRs treated with GKRS were retrospectively analyzed. Thirteen of these 25 patients had histopathological confirmation, and 13 had elevated serum alpha-fetoprotein and beta-human chorionic gonadotropin levels. The 25 patients had a mean follow-up duration of 61 months. The total response rate to GKRS was 60%, and a 53.8% decrease in the alpha-fetoprotein and beta human chorionic gonadotropin levels was observed. The findings of this study indicate that GKRS is a safe procedure for TPRs, even in the event of insufficient histopathological findings. This treatment approach provides increased Karnofsky performance scores and an extended life expectancy.

Kapanma defektleri, santral sinir sistemi ve çevre dokularının embriyolojik gelişim sürecindeki kusurlardan kaynaklanan, hafiften ağır klinik tablolara uzanan bir spektrumdur. Folik asit eksikliği ve çeşitli çevresel faktörler bu anomalilerin gelişiminde kritik rol oynarken, prenatal tanı ve uygun cerrahi müdahaleler yaşam kalitesi ve prognoz açısından büyük önem taşır. Erken teşhis edilen vakalarda cerrahi onarım ve hidrosefali yönetimi, nörolojik kayıpları minimize etmek ve kognitif gelişimi desteklemek için temel tedavi stratejileridir. Neural tube defects arise from developmental anomalies of the central nervous system and surrounding tissues during embryological stages, presenting a clinical spectrum ranging from mild to severe. While folate deficiency and environmental exposures are critical factors, prenatal diagnosis and timely surgical intervention are essential for improving prognosis and quality of life. Early identification, combined with neurosurgical repair and management of associated conditions like hydrocephalus, is vital to minimize neurological deficits and support intellectual development.

Chiari malformasyonları, serebellar tonsillerin foramen magnumdan servikal kanala doğru yer değiştirmesi ile karakterize, hidrosefali ve siringomiyeli gibi komplikasyonlara yol açabilen kraniovertebral bileşke anomalileridir. Tanı ve takibinde MRG altın standart olup, cerrahi dekompresyon BOS akışını düzelterek semptomları hafifleten temel tedavi yaklaşımıdır. Siringomiyeli ise genellikle BOS dolaşım bozukluklarına bağlı olarak omurilikte kistik boşlukların oluşmasıyla seyreden, altta yatan patolojiye yönelik cerrahi müdahale gerektiren bir klinik tablodur. Chiari malformations are congenital craniovertebral junction anomalies characterized by the herniation of cerebellar tonsils, which often lead to secondary complications like hydrocephalus and syringomyelia. Magnetic Resonance Imaging (MRI) serves as the definitive diagnostic tool, while surgical decompression remains the primary treatment to restore normal cerebrospinal fluid (CSF) flow and mitigate neurological deficits. Syringomyelia frequently occurs alongside these malformations due to CSF circulation disturbances, requiring targeted surgical intervention to resolve spinal cord cavities and prevent long-term functional deterioration.

Chronic subdural hematoma (CSH) is one of the most encountered types of intracranial hemorrhage in elderly patients. However reoperation rates are still high, therefore predicting of risk factors for recurrence is essential. In the current study, we aim to identify as many clinical and radiological factors as possible that can predict to the recurrence of CSH.A retrospective review of 291 CSH patients admitted to our department was performed. Clinical and radiological factors predictive for CSH recurrence were identified on univariable analyses at first, and variables with a p-value of <0.05 were entered into the multivariate logistic regression analyses.Univariate analyses revealed that preoperative midline shift (p=0.025), mix-density hematoma (p=0.023), internal architecture of hematoma (p=0.044), membranectomy (p=0.001), and ambient cistern compression (p=0.001) correlated with a significantly higher rate of recurrence. Multivariate analyses showed that seperated architecture, membranectomy and ambient cistern compression were independent risk factors for CSH recurrence. Among many factors, membranectomy, seperated architecture and ambients cistern compression were the strongest predictors for recurrence.

Erciyes Üniversitesi Tıp Fakültesi Çocuk Nörolojisi Bölümünden Prof. Dr. Sefer Kumandaş’ın önderliğinde 500’den fazla yazarın katkısı ile 361 bölüm 4576 sayfa tutan bir Çocuk Nörolojisi kitabının sadece İÇİNDEKİLER listesini gördükten sonra izlenimlerimizi sizlerle paylaşmak istedik. Çocuk Nörolojisi kapsamı içine giren konuların bu kadar fazla olması eğitiminin zorluğunu işaret ettiği gibi kitaptaki konuların okunabilir, öğrenilebilir, faydalanılabilir ve geçerliliğinin de bir göstergesi olacaktır. Tıbbi konularda Türkçe yayınların dünya literatürü ile kıyaslanabilir bir düzeye gelmesi hepimizin hedefi olmalıdır.

Background/aim: In this study, we evaluate sciatic nerve injuries due to intramuscular injections, which is an important medicolegal problem frequently encountered in medical practice, with an extended experimental rat model of peripheral nerve injury. Materials and methods: A total of 78 male Wistar albino rats were divided into five main groups, including a control group, a sham saline group, and groups that received benzathine penicillin G, diclofenac sodium, and dexamethasone, respectively. These pharmaceutical agents were applied to the sciatic nerves of all rats after exploration in the epineurial, endoneurial, and intrafascicular compartments, excluding the control group. Outcomes were evaluated for all rats and their sciatic nerves according to functional, electrophysiological, and histopathological results. Results: Injuries were most evident in the groups that received penicillin G and diclofenac sodium, and this finding was statistically significant. It was also found that endoneurial and intrafascicular injections may cause more harm than epineurial injections. Conclusion: We have demonstrated that any medical injections applied to the epineurial, endoneurial, or intrafascicular compartments of the sciatic nerve may cause functional and electrophysiological loss with or without deterioration of the peripheral nerve architecture.