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    Does Shunt Selection Affect the Rate of Early Shunt Complications in Neonatal Myelomeningocele-Associated Hydrocephalus? A Multi-Center Study
    (Turkish Neurosurgical Soc, 2018) Kahilogullari, Gokmen; Etus, Volkan; Morali Guler, Tugba; Karabagli, Hakan; Unlu, Agahan
    AIM: To evaluate the effect of shunt selection on the rate of shunt revision due to early shunt complications in neonatal myelomeningocele-associated hydrocephalus. MATERIAL and METHODS: The data of 157 neonatal myelomeningocele cases in three pediatric neurosurgery centers (Ankara University, Kocaeli University, Selcuk University) who underwent shunt surgery at the time of myelomeningocele repair between 2000 and 2014 were retrospectively analyzed. Clinical features of the patients, shunt types, and early shunt complications within the first three months were recorded. The patients were classified according to several features of the shunt systems, such as the valve type, valve size/contour and catheter type. RESULTS: Of all patients, 71 (45.2%) underwent early shunt revision surgery due to various complications. Mechanical complications were the most frequent cause of shunt failure, followed by infection. There was no significant difference among the valve types. Also, no significant difference was observed among the catheter types. Only valve contour/size (contoured regular/ultra-small/burr-hole/cylindrical/neonatal) seemed to significantly affect the rate of early complications. The patients with neonatal-design valves or ultrasmall valves had significantly less complications, such as poor wound-healing, wound-dehiscence, cerebrospinal fluid leak or shunt exposure. The infection rate secondary to these complications was found to be lower. CONCLUSION: Myelomeningocele patients with prominent hydrocephalus frequently have a friable skin, due to reduced macrocrania-related subcutaneous tissues. Small-sized (neonatal-design or ultra-small) valves may significantly reduce the early shunt complication rate among this population.
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    Does shunt selection affect the rate of early shunt complications in neonatal myelomeningocele-associated hydrocephalus? A multi-center study
    (2018) Kahılogulları, Gökmen; Etus, Volkan; Guler, Tuğba Moralı; Karabaglı, Hakan; Ünlü, Agahan
    AIM: To evaluate the effect of shunt selection on the rate of shunt revision due to early shunt complications in neonatal myelomeningocele-associated hydrocephalus. MATERIAL and METHODS: The data of 157 neonatal myelomeningocele cases in three pediatric neurosurgery centers (Ankara University, Kocaeli University, Selcuk University) who underwent shunt surgery at the time of myelomeningocele repair between 2000 and 2014 were retrospectively analyzed. Clinical features of the patients, shunt types, and early shunt complications within the first three months were recorded. The patients were classified according to several features of the shunt systems, such as the valve type, valve size/contour and catheter type. RESULTS: Of all patients, 71 (45.2%) underwent early shunt revision surgery due to various complications. Mechanical complications were the most frequent cause of shunt failure, followed by infection. There was no significant difference among the valve types. Also, no significant difference was observed among the catheter types. Only valve contour/size (contoured regular/ultra-small/burr-hole/cylindrical/neonatal) seemed to significantly affect the rate of early complications. The patients with neonatal-design valves or ultrasmall valves had significantly less complications, such as poor wound-healing, wound-dehiscence, cerebrospinal fluid leak or shunt exposure. The infection rate secondary to these complications was found to be lower. CONCLUSION: Myelomeningocele patients with prominent hydrocephalus frequently have a friable skin, due to reduced macrocrania-related subcutaneous tissues. Small-sized (neonatal-design or ultra-small) valves may significantly reduce the early shunt complication rate among this population
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    Effectiveness of multiple endoscopic fenestrations for the treatment of Sylvian fissure arachnoid cysts: a multicenter study
    (Springer, 2023) Guler, Tugba Morali; Sahinoglu, Mert; Sen, Harun Emre; Eker, Oguzhan; Taskapilioglu, Mevlut Ozgur; Karabagli, Hakan; Etus, Volkan
    Purpose Arachnoid cysts are usually asymptomatic lesions. However, they can sometimes cause intracranial hypertension, headache, seizures, focal neurological deficits, and bleeding. The most commonly used surgical techniques are microsurgical cyst fenestration/excision/drainage, cyst shunting, and endoscopic procedures. We aimed to investigate the success of different surgical techniques. Methods Between 2000 and 2021, patients with Sylvan fissure arachnoid cysts who received treatment via an endoscopic approach chosen as the first-line treatment in three centers were enrolled. All case notes and radiological studies were evaluated retrospectively. Results The study included 131 (female, n=28; male, n=103) patients with a mean age of 87.04 +/- 66.76 (range, 0-216) months. Of the patients, 25 had Galassi type II left-sided arachnoid cysts, 33 had Galassi type II right-sided arachnoid cysts, 40 had Galassi type III left-sided arachnoid cysts, and 32 had Galassi type III right-sided arachnoid cysts. No difference was found between patients who underwent single and multiple fenestrations in terms of Galassi type, side, clinical outcome, and cyst size (p> 0.05). On the contrary, the rate of additional surgical intervention was lower in patients with multiple fenestrations than in those with single fenestration (36.10% vs. 5.30%; p <0.001). Conclusion Endoscopic fenestration of Sylvian fissure arachnoid cysts is a good alternative to open surgery or cystoperitoneal shunting, and the number of fenestrations made during this surgery decreases the need for a second surgical procedure.
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    Endonasal endoscopic management of the craniopharyngeal canal meningoencephalocele using a nasoseptal flap in a 6-month-old infant
    (Springer, 2020) Basak, Hazan; Kahilogullari, Gokmen; Guler, Tugba Morali; Sayaci, Emre Yagiz; Etus, Volkan; Meco, Cem
    Endonasal endoscopic approach (EEA) has become a routine and effective method for the management of large skull base defects in adults and increasingly in older pediatric populations despite their challenging narrow transnasal corridors. To our knowledge, this is the first report in the literature of a large craniopharyngeal canal (CC) meningoencephalocele in a 6-month-old infant managed purely through EEA, also by utilizing a pedicled nasoseptal flap (PNF).
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    Repeat endoscopic third ventriculostomy success rate according to ventriculostoma closure patterns in children
    (Springer, 2021) Etus, Volkan; Kahilogullari, Gokmen; Gokbel, Aykut; Genc, Hamza; Guler, Tugba Morali; Ozgural, Onur; Unlu, Agahan
    Purpose This study aimed to examine the success rate of repeat endoscopic third ventriculostomy (redo-ETV) according to pattern of ventriculostoma closure based on observations in 97 paediatric redo-ETV patients. Methods Clinical data and intraoperative video recordings of 97 paediatric hydrocephalus patients who underwent redo-ETV due to ventriculostoma closure at two institutions were retrospectively analysed. We excluded patients with a history of intraventricular haemorrhage, cerebrospinal fluid (CSF) infection or CSF shunt surgery and those with incompletely penetrated membranes during the initial ETV. Results Verification of ventriculostoma closure was confirmed with cine phase-contrast magnetic resonance imaging and classified into 3 types: type 1, total closure of the ventriculostoma by gliosis or scar tissue that results in a non-translucent/opaque third ventricle floor; type 2, narrowing/closure of the ventriculostoma by newly formed translucent/semi-transparent membranes; and type 3, presence of a patent ventriculostoma orifice with CSF flow blockage by newly formed reactive membranes or arachnoidal webs in the basal cisterns. The overall success rate of redo-ETV was 37.1%. The success rates of redo-ETV according to closure type were 25% for type 1, 43.6% for type 2 and 38.2% for type 3. The frequency of type 1 ventriculostoma closure was significantly higher in patients with myelomeningocele-related hydrocephalus. Conclusion For patients with ventriculostoma closure after ETV, reopening of the stoma can be performed. Our findings regarding the frequencies of ventriculostoma closure types and the success rate of redo-ETV in paediatric patients according to ventriculostoma closure type are preliminary and should be verified by future studies.
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    Third ventricle floor variations and abnormalities in myelomeningocele-associated hydrocephalus: our experience with 455 endoscopic third ventriculostomy procedures
    (2017) Etus, Volkan; Guler, Tuğba Moralı; Karabaglı, Hakan
    AIM: To evaluate the incidence of anatomical variations and abnormalities of the third ventricle floor encountered during the endoscopic third ventriculostomy (ETV) procedure in myelomeningocele-associated hydrocephalus (MAH) cases. MATERIAL and METHODS: A retrospective analysis was performed on 455 pediatric MAH cases that had been treated with ETV. This case series consisted of the patients who were initially treated with ETV and also those who were treated with ETV for the management of cerebrospinal fluid shunt dysfunction. Variations and anomalies of the third ventricle floor were determined by reviewing the video records of the ETV procedures. RESULTS: The analysis of the data revealed that the rate of the MAH cases with variations and abnormalities of the third ventricle floor was 41.1%. The most common anatomical features were "thick and prominent massa intermedia" (37.1%) and "narrow tuber cinereum" (33.1%). CONCLUSION: This study documents the most common anatomical variations and abnormalities of the third ventricle floor in cases with MAH. Various anatomical situations and specific ventricular configuration of MAH cases may add an operative factor of difficulty which should be well recognized by the neurosurgeon who plans and executes an ETV procedure in this patient population.