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 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 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 Open Access Surgical Outcomes of Adult Chiari Malformation Type 1: Experience at a Tertiary Institute(2021-09-01T00:00:00Z) Papaker, Meliha Gundag; Abdallah, Anas; Cinar, Irfan; GUNDAG, MELİHABackground Chiari type I malformation (CM1) is a herniation of the caudal cerebellum and/or medulla oblongata into the upper spinal canal, occurring in pediatric and adult populations. We aimed to analyze the surgical outcomes of adult patients with CM1 consecutively treated with a posterior fossa decompression and duraplasty (PFDD) in a tertiary institution. Patients and methods We retrospectively reviewed the medical charts of 45 adult patients with CM1 who underwent PFDD at the Neurosurgery Department of our institution between January 2012 and December 2017. Radiological evaluation was based on pre- and postoperative syrinx/cord ratio, syrinx length, and regression of the ectopic cerebellar tonsils on coronal and sagittal magnetic resonance imaging (MRI) images, and clinical assessment of the patients was performed with the Chicago Chiari Outcome Scale (CCOS). Results Of the 45 patients included in the study, 25 (four men, 21 women) were diagnosed with symptomatic CM1 with an age average of 36.6±11.4 (18-66) years. Headache was the most common symptom (72.0%), while pinprick losses were prevalent in 13 (52.0%) patients. The mean postoperative CCOS score was 14.7±2.0 (8-16). Symptoms improved in 20 patients (80.0%) at the last follow-up. The mean regression in ectopic tonsils on midsagittal and coronal images were 9.1±1.8 (range: 0-16.5) mm and 8.3±1.2 (0-12.0) mm, respectively (p<0.05). The syrinxes had regressed completely or significantly in 7 (87.5%) of eight patients with syrinx. Conclusion Our findings showed that PFDD is sufficient to relieve most of the major symptoms and resolve the syrinx cavity without additional surgical interventions. The CCOS keeps its measurability of assessment of the clinical outcomes. A reliable radiological evaluation should be performed on midsagittal and coronal MRI images.Publication Metadata only Erken Dönem Subaraknoid Kanamanın Serum Endotelin ve von Willebrand Faktörü Üzerindeki Etkisinin Klinik ve Radyolojik Parametrelerle Korelasyonu(2020-09-01T00:00:00Z) Kitiş, Serkan; Gundag, Meliha; Güler, Eray Metin; KİTİŞ, SERKAN; GUNDAG, MELİHAPublication Metadata only Spinal tümörler nedeniyle ameliyat edilen 101 hastanın retrospektif kohort analizi: Tek merkez deneyimi(2020-08-01T00:00:00Z) Kitiş, Serkan; Gundag, Meliha; KİTİŞ, SERKAN; GUNDAG, MELİHAPublication Metadata only Oxidative Stress Level in Patients with Subarachnoid Hemorrhage.(2021-12-12T00:00:00Z) Abdallah, Anas; Guler, Eray Metin; Çınar, İrfan; Papaker, Meliha Gündağ; Dündar, Tolga Turan; Yurtsever, İSMAİL; GUNDAG, MELİHA; ÖZER, ÖMER FARUK; YURTSEVER, İSMAİL; DÜNDAR, TOLGA TURANPublication Metadata only Clinical and radiological evaluation of treated Chiari I adult patients: retrospective study from two neurosurgical centers(2020-10-01T00:00:00Z) Papaker, Meliha Gundag; Abdallah, Anas; ÇEŞME, DİLEK HACER; GÖNEN, GÜVEN; Asilturk, Murad; Avyasov, Rashid; Sofuoglu, Ozden Erhan; Abdallah, Betul Guler; Emel, Erhan; GUNDAG, MELİHA; ÇEŞME, DİLEK HACER; GÖNEN, GÜVENChiari malformation type I (CM1) is a common neurosurgical disorder. It often causes debilitation in the affected patients. CM1 is a herniation of the caudal cerebellum into the spinal canal. This study aimed to evaluate the clinical and radiological outcomes of posterior fossa decompression and duraplasty (PFDD) in treated CM1 patients. In retrospective design, we reviewed the medical records of diagnosed patients with CM1 at two neurosurgical centers spanning 8 years from 2010 to 2017. We selected all CM1 patients who underwent PFDD surgery (n = 72) as the core sample for this study. We used the Chicago Chiari Outcome Scale (CCOS) to evaluate clinical outcomes. Pre- and postoperatively, we assessed the syrinx/cord ratio, the syrinx length, and the improvement of aqueductal stroke volume (ASV) on CSF flow MRIs. The mean value of CCOS was 14.1 +/- 2.1. On midsagittal MRIs, the mean regression in ectopia tonsils was 9.4 +/- 1.9 mm (i.e., mean pre- and postoperative tonsil herniation was 13.1 +/- 3.1 mm and 4.0 +/- 1.6 mm, respectively;p < 0.001). On coronal MRIs, the mean regression in ectopia tonsils was 8.4 +/- 1.5 mm (i.e., mean pre- and postoperative tonsil herniation was 13.9 +/- 2.4 mm and 5.8 +/- 1.0 mm, respectively;p < 0.001). A strong positive correlation was observed between clinical improvement and the increase in ASV values. CSF flow MRIs can help in the surgical decision and follow-up of CM1 patients. ASV <= 12 mu l is a significant predictor for surgical intervention. Full clinical and radiological evaluation utilizing CSF flow MRI are essential. Most syrinx cavities have regressed following PFDD.Publication Metadata only Early stage T1-weighted perfusion magnetic resonance imaging: a factor that predicts local control response in patients with meningioma who underwent gamma-knife radiosurgery(2022-08-01T00:00:00Z) Abdallah, Anas; SEYİTHANOĞLU, MEHMET HAKAN; Papaker, Meliha Gundag; Aralasmak, Ayse; YAPAR, SELÇUK; Baloglu, Gokhan; SEYİTHANOĞLU, MEHMET HAKAN; GUNDAG, MELİHA; ARALAŞMAK, AYŞE; YAPAR, SELÇUKBackground Gamma-knife radiosurgery (GKRS) is an alternative treatment option for selected intracranial meningiomas. The study-s aim is to demonstrate the advantages of T1-weighted perfusion magnetic resonance imaging (T1-PMRI) by measuring the volume transfer coefficient (K-trans) values in the prediction of local response for patients with meningioma who have undergone GKRS consecutively. Methods The data of patients diagnosed radiologically with WHO grade 1 intracranial meningiomas was collected prospectively. The patients who were treated consecutively with GKRS at our institution (September 2017-September 2018) were included. After GKRS, the patients were followed up at the defined periods with routine contrast-enhanced MRI and T1-PMRI by measuring the K-trans. The comparison between the pre-treatment and third-month post-treatment (PO3M) K-trans was done using the Wilcoxon signed-rank test. Results Thirty-one patients with 36 tumors have undergone GKRS. Twenty-two patients were female. The mean age was 55.3 years. The mean pre-GKRS volume was 7.67 ccs. The mean 50% radiation isodose was 12.2 Gy. The local tumor control rate was 100%. Fourteen tumors were regressed fully at the last MRI. PO3M K-trans decreased when compared with the pre-GKRS values (p < 0.0001). However, the numerical decrease in tumor volumes on contrast-enhanced MRI was not statistically significant (p = 0.117). Conclusion Changes between K-trans on PO3M and pre-GKRS T1-PMRI were more useful in determining the early response to GKRS in patients with meningioma than volumetric changes. Therefore, K-trans should be taken as a reference to predict the early response to GKRS in follow-up imaging scans.Publication Metadata only Factors Affecting Long-Term Surgical Outcomes of Spinal Extramedullary Ependymomas: A Retrospective Study.(2022-08-29T00:00:00Z) Abdallah, Anas; Baloğlu, Gökhan; Abdallah, Betül Güler; Papaker, MELİHA; GUNDAG, MELİHA