Person: GUNDAG, MELİHA
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Publication Metadata only The factors affecting the outcomes of conservative and surgical treatment of chiari i adult patients: a comparative retrospective study(2022-02-01T00:00:00Z) Abdallah, Anas; Cinar, Irfan; Papaker, Meliha Gundag; Abdallah, Betul Guler; Sofuoglu, Ozden Erhan; Emel, Erhan; GUNDAG, MELİHABackground The prognosis of the Chiari malformation type 1 (CM1) demonstrates a variant spectrum that varies from full recovery to complicated worse neurological disability. Objective To investigate the factors affecting the outcomes of conservative and surgical treatment for CM1 by evaluating adult patients consecutively managed at our institutions. Materials and methods We retrospectively reviewed the medical records of patients diagnosed with CM1 at two reference neurosurgical centers for eight years (2010-2017). We selected all CM1 adult patients who managed conservatively or surgically as the core sample for this study. For clinical evaluation, we used a Chicago Chiari Outcome Scale (CCOS). For radiological assessment, we adopted both craniocervical and contrast-phase MRIs. We investigate factors such as age, sex, pretreatment symptoms, symptoms duration, and radiological findings in both groups. Results Ninety patients were treated conservatively. After a progression, five of them were treated surgically later and included in a total of 72 patients who underwent decompressive surgery. We successfully managed 85 patients (94.4%) of the conservative group and 64 patients (88.9%) of the surgical group. We found that patients with aqueductal stroke volume (ASV) of 12 mu l are surgical candidates. We observed a strong positive correlation between clinical improvement and the increase in ASV values. Conclusions ASV 13.4 mm on coronal images, low ASV, long symptom durations, and a syrinx are the independent prognostic factors that affected outcomes negatively.Publication Metadata only NÖROFİBROMATOZİS TİP-1’Lİ BİR HASTADA EKZOFİTİK DEV HÜCRELİ GLİOBLASTOMA: OLGU SUNUMU(2017-04-02) GUNDAG, MELİHA; KİTİŞ, SERKAN; SEYİTHANOĞLU, MEHMET HAKAN; DÜNDAR, TOLGA TURAN; GUNDAG, MELİHA; KİTİŞ, SERKAN; SEYİTHANOĞLU, MEHMET HAKAN; DÜNDAR, TOLGA TURANPublication Metadata only Evaluation of balance after surgery for cerebellopontine angle tumor(2019-01-01T00:00:00Z) Canbaz, Nurayet; Atilgan, Esra; TARAKCI, Ela; Papaker, Meliha Gundag; GUNDAG, MELİHABACKGROUND: The origin of about 10% of tumors located in the intracranial region is the cerebellopontine angle. Therefore Cerebellopontine Angle (CPA) tumors affect patients- balance.Publication Open Access An Open Cranial Vault Remodeling Procedure for Craniosynostosis: A Retrospective Study(2022-01-01) Abdallah A.; GUNDAG M.; Baloglu G.; GUNDAG, MELİHACraniosynostosis is a skull malformation occurring due to the premature fusion of one or more cranial sutures. This pathological entity is a relatively commonly observed congenital malformation and is reportedly seen in 1/1,700-1,900 live births. The study aimed to evaluate the surgical outcomes of the open cranial vault remodeling (OCVR) in children with craniosynostosis. Medical records of 76 children with craniosynostosis who were diagnosed at the neurosurgery departments of our centers for 11 years (from January 2010 to December 2020) were retrospectively examined. Among them, 54 consecutive children who underwent OCVR were included in this study. Surgical outcomes were discussed with a related literature review. Fifty-four (32 males and 22 females) consecutive children received OCVR for craniosynostosis with a mean age of 12.6 & PLUSMN; 7.1 months. Eight children were syndromic. Three children were shunt-induced craniosynostosis. Syndromic children were four with Apert, two with Pfeiffer, and two with Crouzon syndrome. Twelve children were brothers/sisters. The misshapen skull was the most commonly recorded symptom in 49 children (90.7%). The most affected sutures were bicoronal craniosynostosis found in 20 children. The complication rate was 9.3% ( n = 5). Two of these five children needed reoperation for optimal remodeling. One child died postoperatively in the intensive care unit due to cardiac arrest. These findings demonstrated that the OCVR approach is an efficient surgical method to get good outcomes. Satisfactory results with an acceptable complication rate can be obtained with expert hands. Further studies are warranted to support these findings.Publication Metadata only VENTRİKÜLO-PERİTONEAL ŞANTIN GEÇ KOMPLİKASYONU: DÖRT OLGUDA PERİTONEAL KATETERİN ANAL PROLAPSUSU(2011-04-26) SEYİTHANOĞLU, MEHMET HAKAN; GUNDAG, MELİHA; DOGAN, KAZIM; KİTİŞ, SERKAN; öztürk, şeref; DÜNDAR, TOLGA TURAN; Çevik, Serdar; SEYİTHANOĞLU, MEHMET HAKAN; GUNDAG, MELİHA; KİTİŞ, SERKAN; DÜNDAR, TOLGA TURANPublication Metadata only Management of Adult Chiari I Patients Based on CSF Flow Magnetic Resonance Imaging: Experience of Two Neurosurgical Centers(2022-07-01T00:00:00Z) Abdallah, Anas; Cinar, Irfan; Papaker, Meliha Gundag; Abdallah, Betul Guler; Emel, Erhan; GUNDAG, MELİHABackground and Study Aims Chiari malformation type 1 (CM1) is one of the most discussed neurosurgical disorders. No consensus exists how to manage adult CM1 patients. We aimed to evaluate all adult CM1 patients consecutively managed at our institutions and discuss our approach based on the phase-contrast (PC) magnetic resonance imaging (MRI). Patients and Methods The medical charts of adult patients diagnosed with CM1 at two referral neurosurgical centers between 2010 and 2017 were reviewed. The patients were either managed conservatively or surgically. We evaluated the patients clinically with the Chicago Chiari Outcome Scale (CCOS). The radiologic diagnosis was based on both craniocervical and PC-MRI. Results Ninety adult CM1 patients were managed conservatively. Conservative treatment failed in 5 of these 90 patients. Seventy-two patients (including those 5 patients who did not benefit from conservative treatment) underwent posterior fossa decompression with duraplasty. Eighty-five patients (94.4%) from the conservative group and 61 patients (84.7%) from the surgical group were treated successfully. An aqueductal stroke volume (ASV) value of 12 mu L was found as the cutoff value for surgical candidates. A strong positive correlation between the increase in ASV values and clinical improvement was observed. Conclusions PC-MRI can help in the management and follow-up of adult CM1 patients. Conservative management is possible in selected symptomatic CM1 patients with a high ASV (ASV > 15 mu L). Surgery should be considered in patients with an ASV 15 mu L require close follow-up. Long-standing symptoms, severe sleep apnea, symptoms influencing functionality, and syrinx are factors that affected outcomes negatively.Publication Metadata only BRAIN TUMOR TREATMENT AND NANOTECNOLOGY(2017-11-08) DÜNDAR, TOLGA TURAN; SEYİTHANOĞLU, MEHMET HAKAN; GUNDAG, MELİHA; gökoğlu, abdulkerim; KİTİŞ, SERKAN; Özek, ERDİNÇ; Abdallah, Anas; Doğan, İhsan; Mutluer, Ahmet Serdar; DÜNDAR, TOLGA TURAN; SEYİTHANOĞLU, MEHMET HAKAN; GUNDAG, MELİHA; KİTİŞ, SERKANPublication Metadata only Comparison of Classical Laminectomy and Transspinous-Split Laminectomy Techniques(2016-07-01) KİTİŞ, SERKAN; SEYİTHANOĞLU, MEHMET HAKAN; GUNDAG, MELİHA; Çevik, Serdar; Emel, Erhan; KİTİŞ, SERKAN; SEYİTHANOĞLU, MEHMET HAKAN; GUNDAG, MELİHAPublication Metadata only Leriche Syndrome With Lumbar Disc Hernia: First Case Report in Literature(2011-01-01) Seyithanoglu, MEHMET HAKAN; Gundag, MELİHA; DOGAN, Kazim; Kitis, SERKAN; Aydin, TEOMAN; PERU, Celalettin; SEYİTHANOĞLU, MEHMET HAKAN; GUNDAG, MELİHA; KİTİŞ, SERKAN; AYDIN, TEOMANLeriche syndrome and lumbar disc herniation have typical clinical findings of their own, although similar findings can form in the lower extremities. Lumbar disc herniation surgery is commonly performed today. With radiological and clinical findings; such as low back and lower limb pain which not heal with medical treatment, motor and sensorial deficit and reflex amendments are indications of surgery. In differential diagnosis of lumbar disc herniation, rare pathologies such as Leriche syndrome should be considered. This syndrome is an occlusive thrombotic lesion of proximal part of bifurcation of abdominal aorta. The characteristic symptoms include inability to maintain penile erection, fatigue of both lower limbs, intermittent bilateral claudication with ischemic pain and absent or diminished femoral pulses along with pallor or coldness of both lower extremities. This patient was operated before with diagnose of lumbar disc herniation because of overlapping of symptoms and after 40 days Leriche syndrome was diagnosed. Vascular lesions should be considered in preoperative differential diagnosis in cases with radiologically and clinically diagnosed lumbar disc herniation. Symptoms should be depend on Leriche syndrome, findings of two disease should be together.Publication Open Access Investigation of Brain Impairment Using Diffusion-Weighted and Diffusion Tensor Magnetic Resonance Imaging in Experienced Healthy Divers.(2018-11-17) SEYITHANOĞLU, MEHMET HAKAN; ABDALLAH, ANAS ABDELRAHIM SA; Dündar, TOLGA TURAN; KITIŞ, SERKAN; ARALAŞMAK, AYŞE; Gündağ, Papaker; SASANI, H; SEYİTHANOĞLU, MEHMET HAKAN; ABDALLAH, ANAS ABDELRAHıM SA; DÜNDAR, TOLGA TURAN; KİTİŞ, SERKAN; ARALAŞMAK, AYŞE; GUNDAG, MELİHABackground: The aim of this study was to understand the changes of decompression illness in healthy divers by comparing diffusion-weighted (DWI) and diffusion tensor MRI findings among healthy professional divers and healthy non-divers with no history of diving. Material/Methods: A total of 26 people were recruited in this prospective study: 11 experienced divers with no history of neurological decompression disease (cohort) and 15 healthy non-divers (control). In all study subjects, we evaluated apparent diffusion coefficient (ADC) and type of diffusion tensor metric fractional anisotropy (FA) values of different brain locations (e.g., frontal and parieto-occipital white matter, hippocampus, globus pallidus, putamen, internal capsule, thalamus, cerebral peduncle, pons, cerebellum, and corpus callosum). Results: ADC values of hippocampus were high in divers but low in the control group; FA values of globus pallidus and putamen were lower in divers compared to the control group. DWI depicted possible changes due to hypoxia in different regions of the brain. Statistically significant differences in ADC values were found in hypoxia, particularly in the hippocampus (p=0.0002), while FA values in the globus pallidus and putamen were statistically significant (p=0.015 and p=0.031, respectively). We detected forgetfulness in 6 divers and deterioration in fine-motor skills in 2 divers (p=0.002 and p=0.17, respectively). All of them were examined using neuro-psychometric tests. Conclusions: Repeated hyperbaric exposure increases the risk of white matter damage in experienced healthy divers without neurological decompression illness. The hippocampus, globus pallidus, and putamen are the brain areas responsible for memory, learning, navigation, and fine-motor skills and are sensitive to repeated hyperbaric exposure