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Publication Open Access Rare and challenging extra-axial brain lesions: CT and MRI fndings with clinico-radiological differential diagnosis and pathological correlation(AVES Ibrahim Kara [email protected] 105/9 Buyukdere Cad Mecidiyekoy,Sisli, Istanbul 34394, 2014) Demir, Mustafa Kemal; Kurtkaya-Yapıcıer, Özlem Sahan; Onat, Elif; Toktaş, Zafer Orkun; Akakın, Akın; Urgun, Kamran; Kılıç, Türker; Demir, Mustafa Kemal, Department of Radiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kurtkaya-Yapicier, Özlem Sahan, Department of Pathology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Onat, Elif, Department of Pathology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Akakin, Akin In, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Urgun, Kamran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kilic, Turker D., Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyThere are many kinds of extra-axial brain tumors and tumor-like lesions, and definitive diagnosis is complicated in some cases. In this pictorial essay, we present rare and challenging extra-axial brain lesions including neuroenteric cyst, primary leptomeningeal melanomatosis, isolated du-ral neurosarcoidosis, intradiploic epidermoid cyst, ruptured dermoid cyst, intraventricular cavernoma, and cavernous hemangioma of the skull with imaging findings and clini-co-radiological differential diagnosis, including the pathologic correlation. Familiarity with these entities may improve diagnostic accuracy and patient management. © Turkish Society of Radiology 2014. © 2014 Elsevier B.V., All rights reserved.Publication Metadata only Association of collagen I, IX and vitamin D receptor gene polymorphisms with radiological severity of intervertebral disc degeneration in Southern European Ancestor(Springer Verlag [email protected], 2015) Toktaş, Zafer Orkun; Ekşi̇, Murat Şakir; Yilmaz, Baran; Demir, Mustafa Kemal; Özgen, Serdar; Kilic, Turker D.; Konya, Deniz; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Ekşi̇, Murat Şakir, UCSF School of Medicine, San Francisco, United States; Yilmaz, Baran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Demir, Mustafa Kemal, Department of Radiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Özgen, Serdar, Department of Neurosurgery, Acıbadem Mehmet Ali Aydınlar Üniversitesi, Istanbul, Turkey; Kilic, Turker D., Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyPurpose: Several genomic loci have been previously found to be associated with intervertebral disc degeneration, so far. Data are mostly derived from northern European countries whereas data derived from Southern European Ancestor are limited. This study aimed to evaluate the association between radiological disease severity of lumbar disc degeneration and certain genetic loci in a sample of participants from Southern Europe. Methods: Seventy-five patients with mild to severe lumbar disc degeneration and 25 healthy controls were enrolled into the study. In each subject, each lumbar intervertebral disc was separately examined to obtain a total radiological score for disease severity. In addition, single-nucleotide polymorphisms of predefined genetic samples were analyzed in all participants: COL1A1 Sp1, COL9a2 Trp2, COL9a3 Trp3, and VDR TaqI. Results: Degeneration scores were significantly worse in cases with COL1A1 Sp1, COL9a3 Trp3, and VDR TaqI mutations, however, COL9a2 Trp2 mutation was not associated with a difference in the severity of disc degeneration. In addition, subjects with mutation in more than one gene sample (n = 20) had significantly worse degeneration scores than the remaining study participants (n = 80) (17.70 ± 2.72 vs. 21.81 ± 1.81, p < 0.001). Conclusion: Single-nucleotide polymorphisms occurring in COL1A1, COL9a3 and VDR genes seem to be associated with the development of lumbar disc degeneration in this cohort, possibly with even more pronounced association when multiple mutations are present in the same individual. By further prospective twin studies in associated genes and analyses of their relationship with environmental factors in an internationally sampled large cohort will make a more clear-minded conclusion about their association with disc degeneration, which would yield better appreciation and clinical planning of some predisposed people for these pathologies. © 2016 Elsevier B.V., All rights reserved.Publication Metadata only Immature ganglioneuroma of the thoracic spine with lipomatous component: A rare cause of scoliosis(Elsevier Inc. [email protected], 2015) Demir, Mustafa Kemal; Kurtkaya-Yapicier, Özlem Sahan; Toktaş, Zafer Orkun; Yilmaz, Baran; Konya, Deniz; Demir, Mustafa Kemal, Department of Radiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kurtkaya-Yapicier, Özlem Sahan, Department of Pathology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Yilmaz, Baran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Gamma Knife treatment of low-grade gliomas in children(Springer Verlag [email protected], 2015) Ekşi̇, Murat Şakir; Yilmaz, Baran; Akakin, Akin In; Toktaş, Zafer Orkun; Kaur, Ahmet Cemil; Demir, Mustafa Kemal; Kilic, Turker D.; Ekşi̇, Murat Şakir, University of California, San Francisco, San Francisco, United States; Yilmaz, Baran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Akakin, Akin In, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kaur, Ahmet Cemil, Department of Pathology, Medical Park Göztepe Hospital, Istanbul, Turkey; Demir, Mustafa Kemal, Department of Radiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kilic, Turker D., Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyBackground: Low-grade gliomas have good overall survival rates in pediatric patients compared to adults. There are some case series that reported the effectiveness and safety of Gamma Knife radiosurgery, yet they are limited in number of patients. We aimed to review the relevant literature for pediatric low-grade glial tumors treated with stereotactic radiosurgery, specifically Gamma Knife radiosurgery, and to present an exemplary case. Case description: A 6-year-old boy was admitted to clinic due to head trauma. He was alert, cooperative, and had no obvious motor or sensorial deficit. A head CT scan depicted a hypodense zone at the right caudate nucleus. The brain magnetic resonance imaging (MRI) depicted a mass lesion at the same location. A stereotactic biopsy was performed. Histopathological diagnosis was low-grade astrocytoma (grade II, World Health Organization (WHO) classification, 2007). Gamma Knife radiosurgery was applied to the tumor bed. Tumor volume was 21.85 cm3. Fourteen gray was given to 50 % isodose segment of the lesion (maximal dose of 28 Gy). The tumor has disappeared totally in 4 months, and the patient was tumor-free 21 months after the initial treatment. Discussion and conclusion: The presented literature review represents mostly single-center experiences with different patient and treatment characteristics. Accordingly, a mean/median margin dose of 11.3–15 Gy with Gamma Knife radiosurgery (GKRS) is successful in treatment of pediatric and adult low-grade glial tumor patients. However, prospective studies with a large cohort of pediatric patients should be conducted to make a more comprehensive conclusion for effectiveness and safety of GKRS in pediatric low-grade glial tumors. © 2015 Elsevier B.V., All rights reserved.Publication Metadata only Lumbar Spinal Immature Ganglioneuroma with Conus Medullaris Invasion: Case Report(S. Karger AG, 2015) Yilmaz, Baran; Toktaş, Zafer Orkun; Akakln, Akln; Demir, Mustafa Kemal; Kurtkaya-Yapicier, Özlem Sahan; Konya, Deniz; Yilmaz, Baran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Akakln, Akln, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Demir, Mustafa Kemal, Department of Radiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kurtkaya-Yapicier, Özlem Sahan, Department of Pathology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyGanglioneuroma (GN) is a benign rare tumor that originates from neural crest cells. It shares a common histogenic family with ganglioneuroblastoma and neuroblastoma and represents the most benign and differentiated form of the group. The most common locations of the GNs are the mediastinum and retroperitoneum. We report an extremely rare case of lumbar spinal GN with conus medullaris invasion and extradural paraspinal extension. A 10-year-old girl presented with a history of worsening lower-back pain and an intermittent tingling sensation in the left leg. Neurological examination revealed reduced sensation in the left L2-L5 dermatomes. Magnetic resonance imaging revealed an intra- and extradural mass extending from the D11 to L5 vertebral body level. There was conus medullaris invasion by the tumor. After L1-L5 laminotomies, the patient underwent tumor resection. Histopathological diagnosis was immature GN. GNs occurring within the spinal column are rare and may grow to a large size. Despite the size and the common involvement of both intra- and extraspinal compartments, the prognosis is usually excellent after complete excision using microsurgical techniques. © 2016 Elsevier B.V., All rights reserved.Publication Metadata only Gorham's disease - Vanishing bone of the cervical spine(Elsevier Inc. [email protected], 2016) Demir, Mustafa Kemal; Kurtkaya-Yapicier, Özlem Sahan; Toktaş, Zafer Orkun; Yilmaz, Baran; Akakin, Akin In; Konya, Deniz; Demir, Mustafa Kemal, Department of Radiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kurtkaya-Yapicier, Özlem Sahan, Department of Pathology, Acıbadem Mehmet Ali Aydınlar Üniversitesi, Istanbul, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Yilmaz, Baran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Akakin, Akin In, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Ossified-calcified intradural and extradural thoracic spinal meningioma with neural foraminal extension(Elsevier Inc. [email protected], 2016) Demir, Mustafa Kemal; Kurtkaya-Yapicier, Özlem Sahan; Toktaş, Zafer Orkun; Akakin, Akin In; Yilmaz, Baran; Konya, Deniz; Demir, Mustafa Kemal, Department of Radiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kurtkaya-Yapicier, Özlem Sahan, Department of Pathology, Acıbadem Mehmet Ali Aydınlar Üniversitesi, Istanbul, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Akakin, Akin In, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Yilmaz, Baran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Lumbar Paget disease with spinal stenosis and conus medullaris compression(Elsevier Inc. [email protected], 2016) Demir, Mustafa Kemal; Kurtkaya-Yapicier, Özlem Sahan; Toktaş, Zafer Orkun; Yilmaz, Baran; Akakin, Akin In; Konya, Deniz; Demir, Mustafa Kemal, Department of Radiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kurtkaya-Yapicier, Özlem Sahan, Department of Pathology, Acıbadem Mehmet Ali Aydınlar Üniversitesi, Istanbul, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Yilmaz, Baran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Akakin, Akin In, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Lumbar nerve root hemangioblastoma and iliac bone cyst in a patient with von Hippel-Lindau disease(Elsevier Inc. [email protected], 2016) Toktaş, Zafer Orkun; Akakin, Akin In; Konya, Deniz; Furuncuoǧlu, Yavuz; Demir, Mustafa Kemal; Kilic, Turker D.; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Akakin, Akin In, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Furuncuoǧlu, Yavuz, Department of Internal Medicine, Bahçeşehir Üniversitesi, Istanbul, Turkey; Demir, Mustafa Kemal, Department of Radiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kilic, Turker D., Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Delayed onset intracranial subdural hematoma following spinal surgery(Lippincott Williams and Wilkins [email protected], 2016) Işik, Semra; Yilmaz, Baran; Ekşi̇, Murat Şakir; Özcan-Ekşi̇, Emel Ece; Akakin, Akin In; Toktaş, Zafer Orkun; Demir, Mustafa Kemal; Konya, Deniz; Işik, Semra, T. C. Sağlık Bakanlığı Hakkari Devlet Hastanesi, Hakkari, Turkey; Yilmaz, Baran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Ekşi̇, Murat Şakir, UCSF School of Medicine, San Francisco, United States; Özcan-Ekşi̇, Emel Ece, UCSF School of Medicine, San Francisco, United States; Akakin, Akin In, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Demir, Mustafa Kemal, Department of Radiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyIn this case-based review, the authors analyzed relevant literature with an illustrative patient of theirs about subdural hematoma secondary to dural tear at spinal surgery. Intracranial hypotension is a condition of decreased cerebrospinal fluid volume and pressure. Even though intracranial hypotension is temporary and can bemanaged conservatively, itmay progress and result in subdural fluid collections, hematoma formations, ''brain sagging or slumping'' states, syringohydromyelia, encephalopathy, coma, and even death. The authors present an 81-year-old man admitted with subdural hematoma 50 days following previous spinal surgery for lumbar spinal stenosis. In his previous spinal surgery he had had dural tear, which had been closed primarily. To the literature, only 21 patients have been reported to develop subdural hematoma following spinal surgery. In patients with subdural hematoma following spinal surgery, the female:male ratio was 3:4 and the median age was 55 years. Surgical diagnoses for previous spinal surgeries were intervertebral disc herniation (5), spinal canal stenosis and spondylolisthesis (6), failed back syndrome (2), tethered cord syndrome and myelodysplastic spine (2), spinal cord tumor, spinal epidural hematoma, vertebral dislocation, vertebral fracture, vertebral tumor, and inflammatory spine. Patients presented with signs and symptoms of subdural hematoma within 6 hours to 50 days following the spinal surgery. Source of cerebrospinal fluid leak was most commonly from lumbar region (13 patients, 62%). Ten of 21 (48%) patients were treated conservatively. Late-onset neurological findings should not prevent the evaluation of cranial vault with computed tomography and magnetic resonance imaging. Spinal dural tear should be more aggressively treated instead of suture alone approach, when recognized in older patients during the spinal surgery. © 2016 Elsevier B.V., All rights reserved.