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    Low-Cost 3-D-Printer-Assisted Personalized Cranioplasty Treatment: A Case Series of 14 Consecutive Patients
    (Elsevier Science Inc, 2023) Kaya, Ismail; Yakar, Huseyin; Kesen, Enes
    OBJECTIVE: The current study used polylactic acid molds [developed locally using three-dimensional printers and our software] and polymethyl methacrylate (PMMA) to perform cranioplasty of bone defects in technically demanding areas of the skull while ensuring ideal cosmetic results and functional recovery. The overall aim was to identify the ideal method for standard cranioplasty procedures -METHODS: Polylactic acid duplicates of the skull defects were created for eligible patients, after which a two-part negative mold composed of plaster and silicone was used to form artificial bone with PMMA. Thereafter, cranioplasty was performed and the treat-ment success was assessed by evaluating the per-centage of similarity objectively and the body image scale subjectively. -RESULTS: No surgical complications were seen to occur in the 14 patients included in the current study. Further-more, the subjective and objective evaluation revealed a significant improvement in outcomes (p < 0.05). No post-operative complications were observed over a follow-up period of 6 months, except in 1 patient who exhibited late infection.CONCLUSIONS: Cranioplasty operations were per-formed at an economical price of approximately US$50 dollars, suggesting that this method can be applied widely. Furthermore, preoperative preparation of the PMMA models can help reduce the duration of anesthesia and surgery which, in turn, will minimize the risk of surgical complications. Based on current knowledge in the field, we believe that this method represents the ideal technique.
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    Shunt Fractures Associated with Intermittent Hydrocephalus: Case Reviews and New Solutions
    (Elsevier Science Inc, 2022) Yakar, Huseyin; Kaya, Ismail
    OBJECTIVE: Although ventriculoperitoneal shunt surgery is the most common method for hydrocephalus treatment, it may lead to serious complications and require surgical interventions. Peritoneal catheter fracture is one of the common complications that may cause intermittent hydrocephalus. If patients with peritoneal catheter fracture have symptoms of hydrocephalus and ventricular dilatation, the treatment algorithm is clear. However, the diagnosis and treatment protocol remains unclear otherwise. In this article, the possible mechanisms of hydrocephalic symptoms, the diagnosis, as well as treatment algorithms are examined. METHODS: Eight patients with a ventriculoperitoneal shunt who had intermittent hydrocephalic symptoms due to peritoneal catheter fracture but without any radiologically significant ventricular dilatation at Nigde Omer Halisdemir University from 2018 to 2021 were collected. A new diagnostic algorithm was created. Patient follow-up was performed in each patient as a procedure. RESULTS: The method that we determined was successful in all our patients. No complications were observed. We have followed the patients with a normal clinic for at least 6 months. CONCLUSIONS: The provocation test we have formulated always revealed the true cause of the clinic. Thus, on the one hand, with a positive provocation test we recommend revision surgery without waiting for the ventricular dilatation or hydrocephalic symptoms in patients with a fractured peritoneal catheter, considering the results of asymptomatic shunt revision surgery have been reported to be better than those with symptomatic shunt dysfunction; on the other hand, patients with negative provocation tests are saved from unnecessary surgical intervention as well as benefit from true etiologic fast treatment.
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    The relationship between sphenoidal sinus and sella turcica morphometry in the Turkish population: a retrospective study
    (Springer France, 2024) Keles, Haci; Yakar, Huseyin; Kaya, Ismail; Cicek, Fatih; Ceranoglu, Faruk Gazi; Ciftci, Ali Turker; Karadag, Huseyin
    Purpose The anatomical position of the sphenoidal sinus (SS) is very important for neurosurgeons because of the trans-sphenoidal approach to the pituitary gland. Therefore, the aim of this study was to determine the volume and shape of the SS and its relationship with the morphometry of the sella turcica. Methods This study included CT images of 282 males and 258 females with a mean age of 50.52 years (range 18-75) who underwent head CT. The morphometric values of the sella turcica and the volume of the SS were measured on the included radiologic images. Measurements were made on the sagittal slice closest to the midline in T1 sequence. Morphometric measurements were made with Micro Dicom Viewers software program and volume measurements were made with ITK SNAP software program. Results In this study, 4 types of SS shapes were obtained in the whole population: amorphous, pentagonal, triangular and quadrilateral. The mean SS volume was 7055.88 mm3 in males and 5694.48 mm3 in females and a statistically significant difference was observed (p < 0.001). In addition, a statistically significant difference was found between the sexes in the width and surface area parameters of the sella turcica (p < 0.05). Conclusion In this study, the morphometric relationship between the shape of the sinus sphenoidale and sella turcica was demonstrated between men and women. In particular, the shape of the sinus sphenoidale was found to be anthropometrically different between men and women in the Turkish population. It is hypothesised that the data obtained in our study will guide surgeons performing transsphenoidal approach.