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Öğe Anevrizmal subaraknoid kanamalı hastalarda endotelyal nitrik oksid sentaz (eNOS) geninin promoter t786c ve intron-4 (27 baz çifti tekrarı) polimorfizmi(Cumhuriyet Üniversitesi, 2011) Söylemez, Burçak; Özüm, ÜnalNitrik oksid sentezi, 3 izoformu bulunan nitrik oksid sentaz enzimi tarafından düzenlenmektedir. Bunlar, endotelyal nitrik oksid sentaz (eNOS), nöronal nitrik oksid sentaz (nNOS) ve indüklenebilir nitrik oksid sentazdır (iNOS). eNOS, arter damar çapını düzenlemektedir. İşlevsel etkinliği dışında yapısal etkinliği de mevcuttur.Bu çalışmada eNOS genindeki iki polimorfizmle bir yapısal damar patolojisi olan kafa içi anevrizmal subaraknoid kanama arasındaki ilişki incelenmiştir.Bu çalışmaya kafa içi anevrizmal subaraknoid kanaması olan 43 hasta ve 46 sağlıklı birey alınmıştır. eNOS geni intron-4 bölgesi 27-VNTR ve ekson 7 bölgesi T786C polimorfizmi analizi yapılmıştır.eNOS geni T786C polimorfzmi için hasta ve kontrol grupları arasında genotip dağılımları yönünden anlamlı fark bulunmuştur. 27-VNTR analizinde hasta ve kontrol grupları arasında anlamlı bir fark bulunmamıştır.eNOS genindeki mutasyon ve polimorfizmlerin, eNOS enziminin işlev bozukluklarına neden olarak kafa içi anevrizmal subaraknoid kanamaya yol açabileceği gösterilmiştir. Bu mutasyon ve polimorfizmin belirlenmesi kafa içi anevrizmal subaraknoid kanama patogenezine ışık tutacaktır.Öğe Coronavirus-19 pandemic and its impact on elective neurosurgical operations(Selçuk BAŞAK, 2022) Küçükyıldız, Halil Can; Şimşek, Salih Kürşat; Söylemez, Burçak; Güneş, Giray; Koç, Fatih; Özüm, ÜnalBackground/Aim: The Coronavirus-19 (COVID-19) pandemic disrupted all planned, elective surgical procedures and appointment-based health services due to the decreased capacity of hospitals, healthcare professionals' focus on fighting the pandemic and efforts to protect patients, society and healthcare workers from the pandemic. The purpose of this study was to ascertain the perspective of patients on elective surgery, who applied to neurosurgery outpatient clinics at two different centers as clean and non-clean hospitals. Methods: This cross-sectional prospective study was performed between March 2021 and July 2021, during the COVID-19 pandemic. 160 patients who were offered elective surgery for various indications in neurosurgery outpatient clinics were enrolled in the study. To this end, a questionnaire was administered to patients that included information about their demographics, pandemic processes and their anxiety levels during this process. Age, level of education, COVID -19 infection and vaccination status were all questioned in the survey. Univariate and multivariate analysis were used to determine the factors that might influence a patient's decision towards surgery. Results: In the univariate analysis of the factors, educational status, pandemic-induced anxiety and whether the hospital is a pandemic hospital or not were identified as statistically significant effective factors in patients' decision to accept surgery (PÖğe EARLY EXPERIENCES WITH ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL SURGERY(2020) Söylemez, Burçak; Durmuş, Kasım; Bora, Adem; Eğilmez, Hatice Reyhan; Özum, ÜnalObjective: Pituitary tumors (PT) constitute 10-15% of intracranial tumors, and 90% of surgically treated PTs are pituitary adenoma (PA). PA can be treated using pharmacologic, surgical, and radiotherapeutic methods. Today, endoscopic endonasal transsphenoidal surgery (EETS) is more commonly performed because it is less invasive, provides a panoramic image, enables better evaluation of anatomic structures and adjacencies, and reduces hospital length of stay compared to other surgical methods. In this study, we evaluated the results of 21 patients who underwent EETS in our clinic. Methods: A total of 21 patients who underwent EETS between 2016 and 2020 in our clinic were evaluated retrospectively. Thirteen(61.90%) of the patients were women, 8 (38.09%) were men, and the mean age was 53.71 (24-73) years. Results: Pathology reports indicated pituitary adenoma in 17 patients, Rathke's cleft cyst in 3 patients, and hypophysitis in 1 patient. Rhinorrhea occurred in 3 patients, transient diabetes insipidus (DI) in 1 patient, and hypopituitarism in 2 patients. Two of the patients died. Conclusion: The acquisition of endoscopic experience involves a learning curve in which there is initially a temporary high incidence of perioperative complications. Compared with the literature, our results are consistent with the beginning of the learning curve.Öğe Ki-67 Proliferation Index Positivity Limit (Cut-off) Value in Meningiomas(Bolu Abant İzzet Baysal Üniversitesi, 2023) Yeldir, Neşe; Doğan, Ezgi; Özer, Hatice; Söylemez, Burçak; Çelikgün, Serkan; Eğilmez, ReyhanObjective: Meningiomas are usually slow-growing grade 1 tumors according to World Health Organization (WHO) classification. Histological and molecular criterias were defined for the determination of meningiomas of high grade and more aggressive. The proliferation activity is also considered among histopathological criterias. A commonly used parameter for determining proliferation activity is the Ki-67 index. This study was formed retrospectively to identife the positivity limit (cut-off) value of the Ki-67 proliferation index in cases diagnosed with meningioma. Materials and Methods: The Ki-67 indices of a total 190 patients diagnosed with meningioma was compared with the histological degrees of the tumors. The ROC analysis method was used in the statistical analysis for Ki-67 values. Results: The mean Ki-67 proliferation index was found to be 6.3% for grade 1, 11.2% for grade 2 and 26% for grade 3 in the cases diagnosed with meningioma in our center. The Ki-67 proliferation index, which can be used in addition to histopathological findings in the distinction of grade 1 and grade 2 meningiomas in our laboratory, was determined as a positivity limit value of 6.5 (p>0.05). Conclusion: The Ki-67 proliferation index in meningioma is an important parameter that can be used to determine the histological grade of atypical meningioma in particular. Although the index seems to be easy to use, it is a value that can create difficulties in borderline cases and also in interobserver and intraobserver evaluations. Therefore, each pathology laboratory should determine the Ki-67 value that they can accept as a limit for meningioma grading.Öğe Management of Neural Tube Defect: A Single-Center Experience(2021) Söylemez, Burçak; Bulut, Zekeriya; Koç, Fatih; Özum, Ünal; Karadağ, ÖzenObjective: Neural tube defects are a heterogeneous and complex group of congenital central nervous system anomalies involving that involve the failed closure of the vertebral column. The spinal cord is frequently affected, and neural tube defects substantially increase the risk of disability and death within the first year of life. Neural malformations are often associated with abnormalities in other organ systems. This study presents our clinical experiences regarding the development and comorbidities of infants with neural tube defect and compares them with the literature.Materials and Methods: This retrospective study included 47 patients (24 females, 23 males) who underwent surgical treatment for neural tube defect in the neurosurgery department of Sivas Cumhuriyet University Faculty of Medicine Training and Research Hospital between 2000 and 2020.Results: Of the 47 patients, 34 (72.34%) had myelomeningocele and 13 (27.65%) had meningocele. Lesion location was thoracolumbar in 38 patients (80.85%), lumbar in 5 (10.63%), lumbosacral in 3 (6.38%), and cervical in 1 patient (2.12%). Twenty-seven patients (57.44%) underwent ventriculoperitoneal shunting due to hydrocephalus. Thirty patients (63.82%) had Chiari malformation type II, 13 (27.65%) had cranial anomalies, and 1 (2.12%) had Down syndrome. In 9 patients, the conus medullaris terminated at or below the L3 vertebral body (19.14%). Two patients (4.25%) died.Conclusion: Because of their multidimensional nature, neural tube defects have various effects on individuals, families, society, and the field of medicine. This study represents a small group of patients with neural tube defects. Cases should be included from other centers to compile more comprehensive data about patients with neural tube defects in Turkey.Öğe Preoperative embolization of meningiomas: Single center experience(2021) Yıldız, Bülent; Söylemez, BurçakAim: The aim of this study was to investigate the contribution of polyvinyl alcohol particle embolization to meningioma surgery. Materials and Methods: The study included 24 patients (19 women, 5 men) who were operated for meningioma at our institution between October 2018 and October 2019. Ten patients underwent tumor embolization with polyvinyl alcohol particles before meningioma surgery, while the other 14 patients were operated directly without embolization. Groups were constituted as with embolized and non-embolized before surgery.Patient and tumor characteristics, embolization procedure, operative blood loss, operative time, and complications were compared between patients with and without preoperative embolization. Results: The patients ranged in age between 28 and 79 years, with a mean age of 54.16±10.50. Mean operative time was 4.59 hours for the embolized patients and 4.72 hours for the non-embolized patients (p>0.05). Mean hemoglobin values were decreased by 1.25 g/dl in the embolized patients and 1.35 g/dl in the non-embolized patients (p>0.05). Conclusion: There were no significant differences in operative time, intraoperative blood loss, or change in hemoglobin level between meningioma patients who underwent preoperative embolization with polyvinyl alcohol particles and those who did not.
