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Publication Metadata only Pure brucellar discitis mimicking lumbar disc herniation: A case report and review of the literature, Lomber disk hernisini taklit eden saf brusellar diskit: Bir olgu sunumu ve literatürün gözden geçirilmesi(2013) Ekşi̇, Murat Şakir; Bayri, Yasar; Özen, Ali; Daǧçinar, Adnan; Konya, Deniz; Ekşi̇, Murat Şakir, Marmara Üniversitesi Tip Fakültesi, Istanbul, Turkey; Bayri, Yasar, Marmara Üniversitesi Tip Fakültesi, Istanbul, Turkey; Özen, Ali, Marmara Üniversitesi Tip Fakültesi, Istanbul, Turkey; Daǧçinar, Adnan, Marmara Üniversitesi Tip Fakültesi, Istanbul, Turkey; Konya, Deniz, Bahçeşehir Üniversitesi, Istanbul, TurkeyBrucellosis is a zoonotic infection, endemic in the Middle East, the Mediterranean region, Central and South America. Osteoarticular involvement is the most common form of the disease process with spinal complications in third place in this group. We presented a 36-yearold male patient with signs and symptoms of lumbar disc herniation. On lumbar magnetic resonance imaging, a right-sided L5-S1 disc extrusion was detected and the patient was operated. Frozen material pointed out an inflammatory process with Brucella melitensis in disc specimen culture. He was put on rifampicin and doxycycline chemotherapies. After 6 months of follow-up, his clinical, laboratory, and radiological findings became normal. Medical treatment was stopped with ongoing routine outpatient follow-ups. Discitis without spondylitis in Brucella infection is very rare. There have been 2 case reports in the literature. Also, Brucella disc infection should be in differential diagnosis of lumbar disc herniation clinic in endemic parts of the world. © 2013 Elsevier B.V., All rights reserved.Publication Metadata only Total spondylectomy of an L3 osteosarcoma, L3 osteosarkomuna total spondilektomi cerrahisi(2013) Yilmaz, Baran; Ekşi̇, Murat Şakir; Toktaş, Zafer Orkun; Konya, Deniz; Yilmaz, Baran, Bahçeşehir Üniversitesi, Istanbul, Turkey; Ekşi̇, Murat Şakir, Department of Orthopedic Surgery-Spine Center, University of California, San Francisco, San Francisco, United States; Toktaş, Zafer Orkun, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Bahçeşehir Üniversitesi, Istanbul, TurkeyPrimary osteosarcoma is a rare malignant osseous tumor of vertebra. Prognosis has been improved with new technologies and surgical techniques. In modern era of spinal surgery en bloc resection has become more popular in these neoplasms. We presented a 19-year-old young man admitted to our clinic with low back pain. An L3 vertebral mass lesion was detected on MRI. CT-guided biopsy result was osteosarcoma. En bloc resection was planned. In the literature, intraoperative blood loss amounts were very high in osteosarcoma cases, so we decided to embolize the tumor pre-operatively. It worked in the surgery that only 700 ml of blood was lost. Although surgery was one staged (combined anterior and posterior approaches), it took 6 hours with 2 surgeons. Definitive diagnosis was osteosarcoma and the patient was referred to oncologists. Embolization should be kept in mind before vertebral tumor surgery to make it smooth and easy. © 2014 Elsevier B.V., All rights reserved.Publication Metadata only Rare solitary primary osseous lesions of the spine in adults, challenges in ct and mr imaging diagnosis with pathological correlation, Yetişkinlerde Nadir Primer Omurga Kemik Kökenli Lezyonları, CT ve MR ile Tanısal Görüntülemenin Patolojik Korelasyonundaki Zorluklar(Ege University Press Bornova Izmir 35100, 2015) Toktaş, Zafer Orkun; Yilmaz, Baran; Akakin, Akin In; Demir, Mustafa Kemal; Kurtkaya-Yapicier, Özlem Sahan; Onat, Elif; Urgun, Kamran; Konya, Deniz; Toktaş, Zafer Orkun, Bahçeşehir Üniversitesi, Istanbul, Turkey; Yilmaz, Baran, Bahçeşehir Üniversitesi, Istanbul, Turkey; Akakin, Akin In, Bahçeşehir Üniversitesi, Istanbul, Turkey; Demir, Mustafa Kemal, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kurtkaya-Yapicier, Özlem Sahan, Bahçeşehir Üniversitesi, Istanbul, Turkey; Onat, Elif, Bahçeşehir Üniversitesi, Istanbul, Turkey; Urgun, Kamran, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Bahçeşehir Üniversitesi, Istanbul, TurkeyThis pictorial essay is a review of the computerized tomography and magnetic resonance imaging of a few solitary primary osseous lesions encountered in the adults. The lesions discussed include giant cell tumor, Langerhans cell histiocytosis, Paget'sdisease, plasmacytoma, fibrous dysplasia and osteoblastoma. Challenges in computerized tomography and magnetic resonance imaging diagnosis of these lesions are mentioned with clinicoradiological differential diagnosis, and include pathological correlation. Although active diagnosis and radiological familiarity of these lesions is crucial for preventing unnecessary examinations or procedures, pathological evaluation is mandatory to establish final diagnosis. © 2015 Elsevier B.V., All rights reserved.Publication Open Access Epidural anesthesia in elective lumbar microdiscectomy surgery: Is it safe and effective?(Turkish Neurosurgical Society info@turkishneurosurgery.org.tr, 2015) Akakın, Akın; Yılmaz, Baran; Akay, Alp; Şahin, Soner; Ekşi̇, Murat Şakir; Konya, Deniz; Akakin, Akin In, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Yilmaz, Baran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Akay, Alp, Department of Anesthesiology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Şahin, Soner, Department of Neurosurgery, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey; Ekşi̇, Murat Şakir, Ortopedic Surgery-Spine Center, University of California, San Francisco, San Francisco, United States; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyAim: The aim of this study was to evaluate effectiveness and safety of epidural anesthesia in elective lumbar microdiscectomy surgery. Material and Methods: Twenty-seven patients (78%, female), who were admitted for single level simple microdiscectomy surgery between May 2012 and December 2013 in single spine center of a university hospital, were enrolled into the study. Clinical evaluations with demographical and per-operative data were collected prospectively. Results: Mean age was 60.04 years. Mean weight, height, and BMI of the study population were 77.7 kg, 160.22 cm, 30.26, respectively. Mean operation duration was 45.56 minutes. Mean VAS score for pain was 0.78 at immediate post-op, 0.52 at 4th hour, and 0.35 at post-operative 24th hour. Ramsay sedation scale (RSS) scores steadily decreased from 2.07 in the immediate post-operative time to 1.93 at 4th hour and 1.88 at 24th hour. The only correlation seen between patient demographics and RSS was body weight seen in immediate post-operative period. Improvements for VAS scores for pain at 4th and 24th hours were 28% and 31%, respectively. Three patients had nausea, one of them vomited after the surgery. All patients were satisfied and would consider epidural anesthesia in future similar surgeries. Conclusion: Epidural anesthesia provides a safe and effective method for elective lumbar microdiscectomy surgery. © 2017 Elsevier B.V., All rights reserved.Publication Open Access Locally aggressive de novo spinal fibromatosis: Case report and review of the literature(Turkish Neurosurgical Society info@turkishneurosurgery.org.tr, 2015) Ekşi̇, Murat Şakir; Türköz, Hüseyin Kemal; Özcan-Ekşi̇, Emel Ece; Akakın, Akın; Toktaş, Zafer Orkun; Konya, Deniz; Ekşi̇, Murat Şakir, UCSF School of Medicine, San Francisco, United States; Türköz, Hüseyin Kemal, Department of Pathology, Marmara Üniversitesi, Istanbul, Turkey; 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; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyFibromatosis is a benign lesion, which originates from proliferating fibroblasts. Although fibromatosis is a benign tumor, it is locally aggressive and invasive. Spinal presentation of fibromatosis is very rare, and case reports are the only source of the clinical knowledge. Herein, we describe the oldest patient having spinal fibromatosis with de novo occurrence and aggressive nature. A 68-year-old female patient admitted to our outpatient clinic with low back pain and neurological claudication. On lumbar spine magnetic resonance imaging, she had spinal canal stenosis with a concomitant lesion in the left longissimus muscle. We did our best to resect the tumor, entirely. The pathology result was consistent with spindle cell lesion. The lesion recurred 6 months after the primary surgery. In the second surgery, we did en bloc resection. Pathology and immunohistochemical analysis results were consistent with fibromatosis. After the second surgery, she had adjuvant radiotherapy. There was nothing other than radionecrosis in the operation site, still after 2 years. In conclusion, radiological work-up is usually insufficient to make fibromatosis diagnosis and whole pathological specimen should be carefully evaluated to achieve the accurate diagnosis. Spinal fibromatosis is very rare and its treatment methods have not universally been conceptualized. However, adjuvant therapies are necessary after en bloc resection. © 2017 Elsevier B.V., All rights reserved.Publication Metadata only Spinal epidural cavernous angioma: Two case reports and review of the literature(Ekin Medical Publishing demirhan@aott.org.tr, 2015) Bayri, Yasar; Ekşi̇, Murat Şakir; Yalçinkaya Koç, Demet; Konya, Deniz; Bayri, Yasar, Department of Neurosurgery, Marmara Üniversitesi Tip Fakültesi, Istanbul, Turkey; Ekşi̇, Murat Şakir, University of California, San Francisco, San Francisco, United States; Yalçinkaya Koç, Demet, Department of Anesthesiology, Marmara Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyCavernous angiomas are vascular malformations that occur most frequently in the supratentorial area of the central nervous system (CNS). Spinal epidural occurrence is rare. This article describes 2 cases of spinal epidural cavernous angioma. The lesions were hypo- to isointense on T1-weighted magnetic resonance images (MRIs) and hyperintense on T2-weighted images. Both were enhanced homogenously with intravenous contrast. Total resection was achieved in both cases, and the lesions were histopathologically diagnosed as cavernous angiomas. The patients' symptoms regressed postsurgery. Although the MRI features of cavernous angiomas are well known, spinal epidural occurrence is rare and many differential diagnoses have similar clinical and imaging findings. It is important to definitively diagnose these lesions prior to surgery in order to prevent possible intraoperative complications such as massive bleeding and to maximize chances for complete resection. In addition to case descriptions, this article includes a thorough literature review to raise clinical awareness about this well-known but rare spinal entity. © 2015 Elsevier B.V., All rights reserved.Publication Open Access Biological approaches to treating intervertebral disk degeneration: Devising stem cell therapies(Cognizant Communication Corporation inquiries@cognizantcommunication.com 3 Hartsdale Road Elmsford NY 10523-3701, 2015) Han, Inbo; Ropper, Alexander Eli; Konya, Deniz; Kabataş, Serdar; Toktaş, Zafer Orkun; Aljuboori, Zaid S.; Zeng, Xiang; Chi, John H.; Zafonte, Ross D.; Teng, Yang D.; Han, Inbo, Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States, Department of Neurosurgery, College of Medicine, Pochon CHA University, Pocheon, South Korea; Ropper, Alexander Eli, Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, United States; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kabatas, Serdar, Department of Neurosurgery, Reyap Hospital, Tekirdag, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Aljuboori, Zaid S., Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States, University of Louisville School of Medicine, Louisville, United States; Zeng, Xiang, Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States, Department of Neurosurgery, College of Medicine, Pochon CHA University, Pocheon, South Korea; Chi, John H., Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States; Zafonte, Ross D., Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital Network, Boston, United States; Teng, Yang D., Department of Neurosurgery, Brigham and Women's Hospital, Boston, United States, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital Network, Boston, United States, Division of SCI Research, VA Medical Center, United StatesIntervertebral disk (IVD) degeneration is a common, chronic, and complex degeneration process that frequently leads to back pain and disability, resulting in a major public health issue. In this review we describe biological therapies under preclinical or clinical development with an emphasis on stem cell-based multimodal approaches that target prevention and treatment of IVD degeneration. Systematical review of the basic science and clinical literature was performed to summarize the current status of devising biological approaches to treating IVD degeneration. Since the exact mechanisms underlying IVD degeneration have not yet been fully elucidated and conservative managements appear to be mostly ineffective, current surgical treatment focuses on removal of the pathological disk tissues combined with spinal fusion. The treatment options, however, often produce insufficient efficacy and even serious complications. Therefore, there have been growing demands and endeavors for developing novel regenerative biology-guided strategies for repairing the IVD via delivery of exogenous growth factors, introduction of therapeutic genes, and transplantation of stem cells, or combinatorial therapies. Overall, the data suggest that when applied under a recovery neurobiology principle, multimodal regimens comprising ex vivo engineered stem cell-based disks hold a high potential promise for efficacious clinical translations. © 2017 Elsevier B.V., All rights reserved.Publication Open Access Cervical myelopathy due to single level disc herniation presenting as intramedullary mass lesion: What to do first?(Wolters Kluwer Medknow Publications, 2015) Ekşi̇, Murat Şakir; Özcan-Ekşi̇, Emel Ece; Yılmaz, Baran; Toktaş, Zafer Orkun; Konya, Deniz; Ekşi̇, Murat Şakir, Department of Orthopedic Surgery-Spine Center, UCSF Medical Center, San Francisco, United States; Özcan-Ekşi̇, Emel Ece, Department of Orthopedic Surgery-Spine Center, UCSF Medical Center, San Francisco, United States; Yilmaz, Baran, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyCervical myelopathy (CM) is mostly a degenerative process ending in myelopathic and/or radiculopathic syndromes. On T2-weighted magnetic resonance imaging (MRI), CM appears as a hyperintense area near the spondylotic spine. This high intensity signal depends on the impact of outer forces and their duration. It also determines the prognosis of the surgical candidate. A 40-year-old male patient admitted to our clinic with right upper extremity weakness and hypoesthesia that had started 2 months earlier. On neurological examination there was 2/5 motor weakness of right biceps brachii, and hypoesthesia over right C6 dermatome. Right upper extremity deep tendon reflexes were hypoactive, but lower ones were hyperactive. After clinical and radiological work-up, preliminary diagnosis was directed to a spinal intramedullary tumor. Total resection of the herniated cervical disc fragment and the mass lesion was managed. Pathology of the mass lesion was compatible with subacute infarct tissue and inflammatory response. Final diagnosis was CM under effect of cervical disc herniation. Contrast-enhanced spinal cord myelopathic lesions are very rare and resemble much more tumors and inflammatory processes. However, the principal treatment approach totally differs depending on pathology. When there are both a disc herniation and a high clinical suspicion, biopsy should be delayed. The most probable solution will be surgery for the disc disease with thorough preoperative scanning of vascular malformations, clinical and radiological close follow-up after surgery. Biopsy or surgical resection can be performed if patient deteriorates despite the primary surgery. © 2021 Elsevier B.V., All rights reserved.Publication Metadata only Anterior transpedicular screw fixation of cervical spine: Is it safe? Morphological feasibility, technical properties, and accuracy of manual insertion(American Association of Neurological Surgeons, 2015) Köktekir, Ender; Toktaş, Zafer Orkun; Şeker, Aśkin N.; Akakin, Akin In; Konya, Deniz; Kilic, Turker D.; Köktekir, Ender, Department of Neurosurgery, Selçuk Üniversitesi, Selçuklu, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Şeker, Aśkin N., Department of Neurosurgery, Marmara Üniversitesi, Istanbul, Turkey; Akakin, Akin In, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kilic, Turker D., Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyOBJECT: Due to lack of construct stability of the current anterior cervical approaches, supplemental posterior cervical approaches are frequently employed. The use of an anterior-only approach with anterior transpedicular screws (ATPSs) has been proposed as a means of providing 3-column fixation. This study was designed to investigate the feasibility of anterior transpedicular screw (ATPS) fixation of cervical spine, to obtain the morphological measurements for technical prerequisites, and to evaluate the accuracy of the ATPS using fluoroscopy. METHODS: The study included both radiological and anatomical investigations. The radiological investigations were based on data from cervical spine CT scans performed in 65 patients. Technical prerequisites of ATPS were calculated using OsiriX for Mac OS. In the anatomical part of the study, 30 pedicles (C3-7) from 6 formalin-preserved cadavers were manually instrumented. Measurements obtained included pedicle width (PW), pedicle height (PH), pedicle transverse angle (PTA), distance of the entry point from the midline (DEPM), and distance of the entry point from the superior endplate (DEPSEP). The authors also analyzed screw position in the manually instrumented vertebrae. RESULTS: The mean PW and PH values showed a tendency to increase from C-3 to C-7 in both males and females. The means were significantly larger for both PW and PH in males than in females at all levels (p = 0.001). The overall mean PTA value was significantly lower at C-7 (p < 0.0001). The mean value for the distance of entry point from the midline (DEPM) represented a point at the contralateral side of the pedicle for every level except C-7. The mean DEPSEP values showed significant differences between all levels (p < 0.0001). Seven of the 30 screws were identified as breaching the pedicle (23.3%), these screw malplacements were seen at C-3 (3 screws), C-4 (2 screws), and C-5 (2 screws). CONCLUSIONS: The morphological measurements of this study demonstrated that ATPS fixation is feasible in selected cases. They indicate that ATPS insertion using a fluoroscopy-assisted pedicle axis view is safe at the C-6 and C-7 levels, but the results at the other levels did not prove the safety of this technique. © 2018 Elsevier B.V., All rights reserved.Publication Metadata only Kyphectomy and Pedicular Screw Fixation with Posterior-Only Approach in Pediatric Patients with Myelomeningocele(S. Karger AG, 2015) Kaplan, Sümeyye Çoruh; Ekşi̇, Murat Şakir; Bayri, Yasar; Toktaş, Zafer Orkun; Konya, Deniz; Kaplan, Sümeyye Çoruh, Department of Neurosurgery, Bismil Devlet Hastanesi, Diyarbakir, Turkey; Ekşi̇, Murat Şakir, UCSF School of Medicine, San Francisco, United States; Bayri, Yasar, Department of Neurosurgery, Marmara Üniversitesi, Istanbul, Turkey; Toktaş, Zafer Orkun, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Konya, Deniz, Department of Neurosurgery, Bahçeşehir Üniversitesi, Istanbul, TurkeyPurpose: Defective posterior spinal arch and paraspinal musculature lead to progressive kyphosis in patients with myelomeningocele. Kyphosis decreases the patients' functional status and quality of life. To correct or prevent further deterioration, different surgical techniques have been introduced. Our aim is to present our clinical experience in kyphectomy and pedicle screw fixation with a posterior-only approach in pediatric patients with myelomeningocele and to discuss the technique with a review of the literature. Materials and Methods: Four patients with lumbar and 2 patients with thoracolumbar kyphosis (female:male ratio = 1:5) secondary to myelomeningocele were operated between January 2009 and October 2012. The median age was 5.5 years (range = 3-10 years). The criteria of the patient selection for the procedure were progression of kyphosis angle, impaired truncal balance and cosmetic deformity. In this retrospective study, we performed chart reviews for demographic and clinical data. We measured the pre- and postoperative kyphosis angles by using the Cobb method on lateral x-rays. Results: The mean preoperative kyphosis angle was 114.3° (range = 91-136°). The mean operative time was 171.7 min (range = 110-220 min). The mean intraoperative blood loss was 450 cc (range = 300-700 cc). The postoperative mean kyphosis angle was 28.2° (range = 13-33°). Five patients had skin breakdown. After osteofusion was established, those 5 patients' instrumentations were explanted. No acute or immediate postoperative complications occurred. Other complications were pneumonia and urinary tract infection. In the long term, 2 patients died due to pneumonia and slit-ventricle syndrome, respectively. Conclusions: Kyphectomy and pedicle screw instrumentation with the posterior-only approach dramatically reduces the kyphosis angle that develops in patients with myelomeningocele. The method itself is less time-consuming and leads to less intraoperative blood loss compared to other methods used for this patient population. Skin breakdown is the most common short-term complication. © 2016 Elsevier B.V., All rights reserved.