Papers by Nurperi Gazioğlu
Turkiye Klinikleri Journal of Pediatric Surgery Special Topics, 2010
Journal of Neurosurgical Sciences, Jun 1, 2009
Our aim in this study was to recognize the endoscopic anatomy of the pterygopalatine fossa (PPF) ... more Our aim in this study was to recognize the endoscopic anatomy of the pterygopalatine fossa (PPF) and the anatomic variations of the related neurovascular structures, to define the endoscopic endonasal approach to this region. Six fresh adult cadavers were studied (N=6) by endoscopic endonasal approach. To reach the pterygopalatine fossa endonasally, we performed the middle meatus transpalatine approach in 2 cadavers, the middle meatus transnasal approach in 2 cadavers and the inferior turbinatectomy transnasal approach in 2 cadavers. The superior and posterior walls of the maxillary sinus were defined and studied. The sphenopalatine foramen is widened by drilling the orbital process of the foramen and the sphenopalatine artery was exposed. The posterior wall of maxillary sinus was opened to expose the pterygopalatine fossa and its neurovascular contents, which were studied and documented. The PPF was easily approached by endoscopic transnasal transmaxillary approach. The PPF region was best exposed by the middle meatus tranasal approach. In the PPF; infraorbital nerve, vidian nerve, major palatine nerve, the infraorbital artery, internal maxillary artery, sphenopalatine artery, descending palatine artery, posterior superior alveolar artery and buccal artery were exposed. According Morton and Khan morphologic classification of the third portion of the internal maxillary artery we found intermediate type in 2 cadavers (33.3%), M' type in 2 cadavers (33.3%), T' type in 1 cadaver (16.7%) and Y' type in 1 cadaver (16.7%). Also, according to Chio and Park classification of the branching type of the infraorbital artery, posterior superior alveolar artery and deep palatine artery, we found type I in 4 cadavers (66%) and type II in 2 cadavers (33%). During the endoscopic transnasal transmaxillary approach to the PPF, it is possible to face wide range of variations in every phase of the approach. Understanding the anatomy of this region and the neurovascular relations from the endoscopic view by cadaver dissections will help us to performed more controlled and safe surgery.
Endocrine, Jan 17, 2015
Aromatase, a key enzyme in local estrogen synthesis, is expressed in different pituitary tumors i... more Aromatase, a key enzyme in local estrogen synthesis, is expressed in different pituitary tumors including growth hormone (GH)-secreting adenomas. We aimed to evaluate aromatase, estrogen receptor α (ERα), estrogen receptor β (ERβ), pituitary tumor transforming gene (PTTG), and fibroblast growth factor 2 (FGF2) expressions in GH-secreting adenomas, and investigate their correlation with clinical, pathologic, and radiologic parameters. This cross-sectional study was conducted in a tertiary center in Turkey. Protein expressions were determined via immunohistochemical staining in ex vivo tumor samples of 62 patients with acromegaly and ten normal pituitary tissues. Concordantly increased aromatase, PTTG, and FGF2 expressions were detected in the tumor samples as compared with controls (p < 0.001 for all). None of the tumors expressed ERα while ERβ was detected only in mixed somatotroph adenomas. Aromatase, ERβ, PTTG expressions were not significantly different between patients with a...
Journal of Craniofacial Surgery, 2015
Skull base endoscopy in the treatment of brain abscesses has been rarely published. Moreover, end... more Skull base endoscopy in the treatment of brain abscesses has been rarely published. Moreover, endoscopic endonasal transethmoidal approach (EETA) for the treatment of brain abscess following a head trauma has been reported only in a few case reports. We report the management of a patient of intracerebral abscess and reconstruction of the accompanying anterior skull base defect through an EETA.Thirty-year-old male with a frontal lobe abscess due to a penetrating skull base trauma was operated via EETA. After drainage of the abscess, dural and bony defects were repaired to prevent any recurrence. Postoperative radiological imaging revealed prominent decrease in abscess size. The patient did not need any further surgical intervention, and antibiotherapy was adequate.EETA is safe and effective in the management of brain abscesses. Skull base endoscopy provides direct visualization of the abscess cavity through a minimal invasive route, facilitates wide exposure of surrounding neurovascular structures within the operative field, and enables concurrent closure of the skull base defect.
Turkish neurosurgery
Our aim in this study was to identify the endoscopic anatomy of the anterior cranio-vertebral jun... more Our aim in this study was to identify the endoscopic anatomy of the anterior cranio-vertebral junction to be able to perform minimal invasive endoscopic surgical procedures to this region (such as dens resection) safely with better postoperative performance of the patients. Five fresh adult cadavers were studied (n=5). We used Karl Storz 0 and 30 degree, 4mm, 18 cm and 30 cm rod lens rigid endoscope in our dissections. After cadaveric specimen preparation, we approached the anterior cranio-vertebral junction by binostril extended endoscopic endonasal approach. The cranio-vertebral junction was located by orientating the endoscope between -10 to +10 degrees. The rhinopharynx was widely exposable after resection of the vomer. The safe lateral limit of this approach was the occipital condyles and foramen lacerum. We could perform odontoid process resection with a pure endoscopic endonasal approach. Our anatomic study offered the facility to learn the endoscopic anatomy of the anterior ...
Turkish neurosurgery, 2009
Our aim in this study was to identify the endoscopic anatomy of the anterior cranio-vertebral jun... more Our aim in this study was to identify the endoscopic anatomy of the anterior cranio-vertebral junction to be able to perform minimal invasive endoscopic surgical procedures to this region (such as dens resection) safely with better postoperative performance of the patients. Five fresh adult cadavers were studied (n=5). We used Karl Storz 0 and 30 degree, 4mm, 18 cm and 30 cm rod lens rigid endoscope in our dissections. After cadaveric specimen preparation, we approached the anterior cranio-vertebral junction by binostril extended endoscopic endonasal approach. The cranio-vertebral junction was located by orientating the endoscope between -10 to +10 degrees. The rhinopharynx was widely exposable after resection of the vomer. The safe lateral limit of this approach was the occipital condyles and foramen lacerum. We could perform odontoid process resection with a pure endoscopic endonasal approach. Our anatomic study offered the facility to learn the endoscopic anatomy of the anterior ...
Turkish neurosurgery, 2009
To recognize the endoscopic anatomy of the surgical corridor along the nasal cavity, sphenoidal s... more To recognize the endoscopic anatomy of the surgical corridor along the nasal cavity, sphenoidal sinus and the sellar area to delineate the pure endoscopic endonasal transsphenoidal approach (EETSA) to the region of the pituitary gland. The endoscopic anatomy of the nasal cavity, sphenoid sinus and the sellar region was studied in 30 fresh cadavers (mean age 42.1 / range 18-66) and dissections were performed in a stepwise manner to simulate EETSA to the sellar region. The sphenoid ostium, located 14.9 mm superior to the choana, was identified at the midpoint between the nasal septum and the superior turbinate in 23 specimens. The shape of the sphenoid ostium was linear (35%), fusiform (30%), oval(22%) or circular (13%). The mean width of the pituitary gland was 14.3 mm and the average minimum distance between the internal carotid arteries on both sides ranged between 13 to 22 mm. Following total hypophysectomy in 12 specimens, the width and length of diaphragma sellae was measured 10...
The Turkish journal of pediatrics
A 3.5-year-old boy was admitted with febrile convulsion for the first time. The patient had a med... more A 3.5-year-old boy was admitted with febrile convulsion for the first time. The patient had a medical history of in vitro fertilization (IVF) and premature delivery in the 21st week of pregnancy. Further, he suffered from neonatal germinal matrix hemorrhage and intraventricular hematoma (IVH). The patient was treated in the pediatric intensive care unit. Cranial magnetic resonance imaging (MRI) showed resorption of the hematoma with the presence of cavum vergae (CV) variation. The new brain MRI revealed progression of the cavum to a large CV cyst compared with the previous imagings, causing pressure upon both lateral ventricles. Endoscopic fenestration of the lateral walls of the cyst with lateral ventricles was performed. The postoperative period was uneventful and the patient was discharged the next day. Followup MRI one year after surgery showed normal ventricle size, shrinkage of the cyst and cerebrospinal fluid (CSF) flow between the cyst and the lateral ventricles. This is an ...
Medical science monitor : international medical journal of experimental and clinical research, 2007
The cyclin D1 gene (CCND1) is a proto-oncogene playing a critical role in the transition through ... more The cyclin D1 gene (CCND1) is a proto-oncogene playing a critical role in the transition through the G1 to the S phase of the cell cycle and is overexpressed in many tumors. G870A polymorphism at the exon4/intron4 splicing region of the CCND1 gene may play a role in pituitary tumorigenesis and invasiveness. The objective of this study was to examine CCND1 polymorphism in patients with different types of sporadic pituitary adenomas. One hundred thirty patients (38 male, 92 female, mean age: 45.37+/-13.55 SD years) with sporadic pituitary adenomas (PA group) and 129 healthy controls (HC group) were included in the study. The CCND1 G870A polymorphism in PA and HC were genotyped by PCR-RFLP using peripheral blood samples. CCND1 expression was also evaluated with an immunohistochemical method in tumor tissues of 39 patients of the PA group. The genotype distribution in the PA [AA: 30 (23.1%), AG: 90 (69.2%), GG: 10 (7.7%)] was statistically different from the HC group [AA: 36 (27.9%), AG...
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
A case report of acute traumatic orbital encephalocele related to orbital roof fracture and its m... more A case report of acute traumatic orbital encephalocele related to orbital roof fracture and its management were presented. Acute traumatic encephalocele related to orbital roof fracture is unusual. Early diagnosis and treatment are very important since the raised intraorbital pressure may irreversibly damage the optic nerve. Orbital computerized tomography with thin axial and coronal sections should be performed in an acute traumatized patient with a concurrent orbital trauma. Reconstruction of the orbital roof is the key step of the surgical treatment and should be performed in every case. Porous polyethylene (Medpor) has been used for many years in reconstructive surgeries and it is superior to other allografts in many ways. In our case, the orbital roof reconstruction was done by Medpor and the early and late cosmetic results were excellent. The important features of acute traumatic encephalocele secondary to orbital roof fractures in terms of presentation, diagnosis and surgical...
Turkish Neurosurgery, 2009
The authors report a case of large arachnoid cysts of the posterior fossa treated by endoscopic s... more The authors report a case of large arachnoid cysts of the posterior fossa treated by endoscopic surgery. A 40-year-old man was admitted with a 3-month history of headache and progressive gait imbalance, with no significant medical history. At the time of admission, neurological examination revealed no abnormalities except for tandem imbalance. Brain computerized tomography (CT) scan and magnetic resonance imaging (MRI) revealed a posterior fossa arachnoid cyst (PFAC) causing brain stem compression accompanied by hydrocephalus. The patient was treated by endoscopic fenestration of the cyst with a paramedian suboccipital transcortical approach. Postoperatively the patient's complaints showed improvement and he was discharged with no complications. Follow up MRI showed a decrease in the cyst's size and the hydrocephalus with decompression of the brain stem.
Central European Neurosurgery, 2010
Giant cell tumors (GCT) are benign, but locally aggressive primary bone neoplasms, that frequentl... more Giant cell tumors (GCT) are benign, but locally aggressive primary bone neoplasms, that frequently occur in the epiphyses of the long bones. Less than 1% of all GCTs primarily involve the skull where they are preferentially seen in the sphenoid and temporal bones. In the pediatric age group they are exceptionally rare. The authors report the management of a GCT involving the frontal bone in an 18-month-old girl. The patient underwent wide surgical excision of the lesion and remains free of clinical and radiological evidence of tumoral recurrence thirty months after treatment. Although rare, GCTs should be taken into consideration as a differential diagnosis of rapidly enlarging cranial mass lesions in pediatric patients. Gross total surgical excision eliminates the potential risks of adjuvant radiotherapy. However, considering the aggressive nature and potential malignancy of these lesions, careful long-term clinical and imaging follow-up is recommended.
Surgical and Radiologic Anatomy, 2010
Objective The objectives of this study were to recognize the endoscopic anatomy of the cavernous ... more Objective The objectives of this study were to recognize the endoscopic anatomy of the cavernous sinus and to understand the standard, purely endoscopic endonasal approaches to this anatomic structure. This basic information will facilitate our surgical procedures and decrease the rate of surgical complications. Materials and methods Seven fresh adult cadavers were studied bilaterally (n = 14). We used Karl Storz 0 and 30°, 4 mm, 18 cm and 30 cm rod lens rigid endoscope in our dissections. After cadaver preparation, extended endoscopic endonasal approaches were performed to access the cavernous sinus. Results In the seven cadavers, the cavernous sinus and superior orbital fissure, on both sides, were widely exposed with extended endoscopic endonasal approach. The anteroinferior portion of the cavernous sinus was exposed by removing the superior and the middle turbinates and the posterior ethmoidal cells (extended endoscopic endonasal transsphenoidal approach); the whole lateral wall of the cavernous sinus was exposed by removing the anterior and the posterior ethmoidal cells (endonasal ethmoido-pterygosphenoidal approach: far lateral); and the medial wall of the cavernous sinus was exposed by introducing the 30°endoscope from the contralateral nostril (contralateral endoscopic endonasal transsphenoidal approach). According to the neurovascular architecture, the lateral wall of the cavernous sinus is divided into the superior triangular area, the superior quadrangular area and the inferior quadrangular area. This division can facilitate understanding of the anatomic relations of the cavernous sinus from the endoscopic view. Conclusion Knowledge of the anatomy of the cavernous sinus obtained with an endoscopic view of cadaver dissections is an essential step in the learning curve of endoscopic skull base surgery, and is important for endoscopic treatment of various pathologies in this region. In this anatomic study, we reviewed the approaches to the cavernous sinus with an endoscopic view and identified the neurovascular relations. This approach will help in performing safer and minimally invasive surgery.
Pituitary, 2008
Leptin is a key mediator in the maintenance of neuroendocrine homeostasis. The aim of this study ... more Leptin is a key mediator in the maintenance of neuroendocrine homeostasis. The aim of this study was to determine the changes in serum leptin, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), nitric oxide (NO) levels in patients with hyperprolactinemia. The study consists of 16 consecutive patients with high prolactin (PRL) levels (group I) and a control group of 11 normoprolactinemic patients (group II). Pituitary tumor tissues of patients in groups I and II were analyzed for immunohistochemical (IHC) expression of prolactin and leptin. Group I has significantly higher levels of leptin than group II (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). There is a strong correlation between PRL and leptin concentrations in group I. However, there were no statistically significant differences for NO, TNF-alpha, IL-6 between the two groups. IHC staining showed that there was strong immunoreactivity for leptin protein in PRL-secreting pituitary adenomas. Double immunostaining of adenoma tissues with PRL and leptin showed that the adenoma cells expressed both. These findings together are suggestive that leptin co-secretion from a prolactinoma may be the cause of increased serum leptin concentration, independently from the peripheral action of prolactin.
Pituitary, 2010
The aim of the study was to screen the malignancy in an acromegalic patient group and to determin... more The aim of the study was to screen the malignancy in an acromegalic patient group and to determine whether there was any increased risk and the incidence of malignancy and its association with disease characteristics such as duration of disease, latency in diagnosis, and GH and IGF-1 levels. One hundred-five (65 female, 40 male) patients with acromegaly followed and treated at Cerrahpasa Medical School, Endocrinology and Metabolism outpatient clinic between 1983 and 2007 were included in this study. The patients were screened with colonoscopy, mammography, and thyroid and prostate ultrasonography (US). Malignancy was detected in 16 (15%) patients. Thyroid cancer was found in 5 patients (4.7%), breast cancer in 3 (2.8%), colon cancer in 2 (1.9%), lung cancer in 2 (1.9%), cervix cancer in 1 (0.9%), myelodysplastic syndrome (MDS) in 1 (0.9%), cholangiocarcinoma in 1 (0.9%), and multiple endocrine neoplasm (MEN) type 1 in 1 patient (0.9%). Cancer was more common in the male patients (P = 0.046) and high levels of GH increased the risk of cancer development (P = 0.046). In this series, the most commonly detected cancer types were thyroid followed by breast and colon cancers. Although high levels of initial GH seemed to increase the risk of cancer development in acromegalic patients, age, gender, age at the time of diagnosis, duration of disease, and initial IGF-I levels were not associated with cancer development.
Pituitary, 2007
Aromatase (P450AROM) converts testosterone to estrogen. This conversion could be important in nor... more Aromatase (P450AROM) converts testosterone to estrogen. This conversion could be important in normal physiology and estradiol-induced tumorigenesis in human pituitary. The objective of this study was to examine the expression of P450AROM in normal human pituitary and determine the gender difference. We examined aromatase expression in 19 normal human pituitary glands [13 males, 6 females, median age: 30 years (interquartile ranges, IQR: 23-63)] obtained from autopsy. We demonstrated aromatase gene expression levels by quantitative RT-PCR and aromatase protein with immunohistochemical staining in normal male and female human pituitary. Although median relative expression level of aromatase mRNA of male individuals [median DeltaCt = 42.6 (IQR: 7.6-93.9)] was higher than the female individuals [median DeltaCt = 3.9 (IQR:0-44.8)], we could not determine a significant gender difference in aromatase mRNA levels (p = 0.2). The difference between the aromatase protein density by immunohistochemistry was not significant between genders (p = 0.78). The aromatase levels were also not correlated with the age of the study subjects (p = 0.42 r = -0.21). The results indicate that aromatase enzyme is present in human pituitary. The amount and the density of the enzyme show a large variance among different individuals. Although higher mRNA expression was observed in male pituitary compared to female pituitary, there was no statistically significant difference for gender or age.
Journal of Craniofacial Surgery, 2014
The authors share their experience on a collision tumor of growth hormone (GH)-secreting adenoma ... more The authors share their experience on a collision tumor of growth hormone (GH)-secreting adenoma and gangliocytoma in the pituitary gland, which was reported by few articles in the literature. Also, an intraoperative view of this tumor, operated via endoscopic endonasal transsphenoidal approach, is presented for the first time. A 39-year-old female patient was admitted with clinical manifestation of acromegaly present in a 2-year period. Laboratory investigations revealed high levels of GH and insulinlike growth factor 1. Sellar computed tomography scan and magnetic resonance imaging showed a sellar mass diagnosed as a pituitary adenoma. Based on clinical, biochemical, and radiologic evaluations, GH-secreting pituitary adenoma was diagnosed and operated by endoscopic endonasal transsphenoidal approach achieving total removal of the tumor. Histopathologic examination revealed a collision tumor of GH-secreting adenoma and gangliocytoma. Postoperative radiologic and biochemical investigations showed no residual tumor and total remission. The endoscopic endonasal transsphenoidal approach promotes a close intraoperative view of sellar pathologies. We believe that a detailed histopathologic workup is necessary to diagnose collision tumors, because even a close intraoperative view does not facilitate to differentiate these tumors from a regular pituitary adenoma.
Surgical and Radiologic Anatomy, 2012
[corrected] In spite of the extensive case studies considering thoracoscopic approaches to the an... more [corrected] In spite of the extensive case studies considering thoracoscopic approaches to the anterior thoracic spine, the literature lacks studies of the thoracoscopic anatomic dissection and approaches. In this article, the authors present their study of thoracoscopic anatomy of the anterior spine with illustrated step-wise dissection and approaches for sympathectomy, discectomy and corpectomy. Four adult cadavers with no history of disease, local trauma or surgery were studied and bilateral thoracoscopic anterior spinal approaches were performed. Thoracoscopic dissections were done in the Department of Anatomy, using Karl Storz 30°, 5 mm and 30 cm rod lens rigid endoscope (Karl Storz and Co., Tuttlingen, Germany). As surgical instrumentation, Karl Storz Rosenthal endoscopic surgical set and 15 mm portals were used for all approaches. For sympathectomy, the cadaver is positioned supine and the port locations are in the third and fifth intercostal spaces in the anterior axillary line. The stellate ganglion is cephalad to the second rib, and the T2 and T3 ganglia are divided just superior to T2 ganglia and inferior to T3. For discectomy, the cadaver is positioned in the lateral decubitus position. The working portal is positioned directly over the affected disc in the posterior axillary line. The camera portal is positioned in the middle axillary line; 2-3 intercostal spaces caudal to the working portal. The rib head is removed and the lateral surface of the pedicle and neural foramen are exposed. The pedicle and the floor of the spinal canal are resected to decompress the ventral aspect of the spinal canal. For corpectomy, the position of the cadaver and ports are as same as for discectomy. The adjacent segmental vessels are divided first, and the discs above and below the targeted corpus are removed. The ipsilateral pedicle is then removed to decompress the anterior spinal cord, followed by median corpectomy. Thoracoscopic approaches are minimally invasive procedures and they can be used safely in patients who need anterior exposure to the thoracic spine for the treatment of a spectrum of diseases. Knowledge of the normal anatomy and thoracoscopic cadaver dissection are essential steps in improving the learning curve.
Pediatric Radiology, 2009
A 1-month-old boy with shortness of extremities on prenatal US was referred to our department wit... more A 1-month-old boy with shortness of extremities on prenatal US was referred to our department with a provisional diagnosis of achondroplasia. His height was normal but he had short extremities and platyspondyly, premature carpal epiphyses on both hands, and short tubular bones with irregular metaphyses on radiographs. Re-evaluation of the patient at the age of 1 year revealed very short height and premature calcification of the costal cartilages and epiphyses. Spondylometaepiphyseal dysplasia (SMED), short limb-abnormal calcification type was diagnosed. This condition is a very rare autosomal recessively inherited disorder, and most of the patients die in early childhood due to neurological involvement. At the age of 2 years and 5 months, a CT scan showed narrowing of the cervical spinal canal. One month later he died suddenly because of spinal cord injury. In conclusion early diagnosis is very important because the recurrence risk is high and patients may die due to early neurological complications. The time of onset of abnormal calcifications, a diagnostic finding of the disease, is at the age of around 1 year in most patients. When abnormal calcifications are not yet present, but radiological changes associated with SMED are present, this rare disease must be considered.
Neurosurgery, 2009
We aim to report a case of Kaposi sarcoma (KS) with Cushing&amp;amp;amp;amp;amp;amp;amp;amp;a... more We aim to report a case of Kaposi sarcoma (KS) with Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome caused by endogenic glucocorticoid-induced immunosuppression. A 43-year-old woman presented with delirium, hirsutism, fatigue, and hypertension. At the time of presentation, physical findings showed a Cushingoid appearance, with moon-like facies, hirsutism, and hyperpigmentation. Laboratory findings showed the following: adrenocorticotropic hormone, 86.7 pg/mL (normal range, 0-46 pg/mL); baseline cortisol level, 50 microg/dL (normal range, 6.2-19 microg/dL); potassium, 2.2 mEq/L (normal range, 3.5-5 mEq/L); and midnight cortisol level, 33 microg/dL. Serum cortisol levels failed to suppress after low and high doses of dexamethasone; these findings confirmed the diagnosis of ectopic adrenocorticotropic hormone production. Magnetic resonance imaging revealed a 12 x 15-mm, round, hypothalamic mass lesion in the center of the median eminence. Endoscopic biopsy from the floor of the third ventricle was performed, and pathological examination of the lesion showed a diffuse adrenocorticotropic hormone-secreting adenoma. The patient developed diffuse skin lesions that were proven to be a KS by skin biopsy while she was prepared for transcranial surgery. After surgical removal of the adenoma, she became hypocortisolemic and required cortisol replacement. Within 1 month after surgery, all KS lesions disappeared spontaneously. Excessive cortisol may induce immunosuppression. KS is one of the most common malignant tumors of patients with immunosuppression. To the best of our knowledge, this is the first case of Cushing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome with KS caused by endogenous glucocorticoid-induced immunosuppression.
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Papers by Nurperi Gazioğlu