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Öğe Cabazitaxel causes a dose-dependent central nervous system toxicity in rats(Elsevier, 2016) Karavelioglu, Ergun; Gonul, Yucel; Aksit, Hasan; Boyaci, Mehmet Gazi; Karademir, Mustafa; Simsek, Nejdet; Guven, MustafaBackground: Chemotherapeutic agents may lead to serious neurological side effects, which in turn can deteriorate the quality of life and cause dose limiting. Direct toxic effect or metabolic derangement of chemotherapeutic agents may cause these complications. Cabazitaxel is a next generation semi-synthetic taxane derivative, which is effective in both preclinical models of human tumors sensitive or resistant to chemotherapy and in patients with progressive prostate cancer despite docetaxel treatment. Aim: The primary aim of this study was to investigate the central nervous system toxicity of Cabazitaxel. Secondary aim was to investigate the safety dose of Cabazitaxel for the central nervous system. Methods: A total of 24 adult male Wistar-Albino rats were equally and randomly divided into four groups as follows: group 1 (Controls), group 2 (Cabazitaxel 0.5 mg/kg), group 3 (Cabazitaxel 1.0 mg/kg) and group 4 (Cabazitaxel 1.5 mg/kg). Cabazitaxel (Jevtana, Sanofi-Aventis USA) was intraperitoneally administered to groups 2, 3 and 4 at 05, 1.0 and 1.5 mg/kg (body-weight/week) doses, respectively for four consecutive weeks. Beside this, group 1 received only i.p. saline at the same volume and time. At the end of the study, animals were sacrificed and bilateral brain hemispheres were removed for biochemical, histopathological and immunohistochemical examinations. Results: Intraperitoneal administration of Cabazitaxel has exerted neurotoxic effect on rat brain. We have observed that biochemical and immunohistochemical results became worse in a dose dependent manner. Conclusion: Our findings have suggested that Cabazitaxel may be a neurotoxic agent and can trigger apoptosis in neuron cells especially at high doses. (C) 2015 Elsevier B.V. All rights reserved.Öğe Chronic Spinal Epidural Hematoma in an Adult(Modestum Ltd, 2015) Tokmak, Mehmet; Aras, Adem Bozkurt; Altiok, Inci Baltepe; Guven, Mustafa; Cosar, MuratSpinal epidural hematoma (SEH) causing neurological deficit is a rare clinical entity. It may have either traumatic origin or it may occur spontaneously. Majority of the reported cases of SEH had nontraumatic causes and most of them were in the acute stage. Early chronic traumatic SEH in an adult is very rare and its prompt diagnosis with magnetic resonance imaging (MRI) is crucial for the accurate management of the patient. Our case was 56 year-old man presented at our neurosurgery clinic with a complaint of progressive burning pain, weakness, paresthesia over the left leg and hypoesthesia over the pelvic region. In this report, we presented a postraumatic lumbar SEH which is a unique presentation of chronic traumatic SEH because of long time interval between the trauma and beginning of the symptoms.Öğe Comparison of Anterior Cervical Discectomy Fusion Techniques: Bladed and Non Bladed PEEK Cages(Turkish Neurosurgical Soc, 2016) Guven, Mustafa; Cosar, Murat; Alkan, Bahadir; Aras, Adem Bozkurt; Akman, Tarik; Safak, Ozbey; Karaarslan, OznurAIM: The aim of this study is to compare the different types of fusion materials known as PEEK cages used during anterior cervical discectomy (ACD) surgery. MATERIAL and METHODS: A total of 67 patients were operated and evaluated retrospectively under two groups (group A: 35 PEEK cage patients, group B: 32 bladed PEEK cage patients) between 2009 and 2013. Preoperative and postoperative (postoperative first day, postoperative 1st, 3rd and 12-24th mo) images were obtained. The cervical disc heights, cervical and segmental lordotic angles of the operated levels were calculated. Pain assessment was performed and fusion rates were also compared. Mann-Whitney U test was applied to compare the outcomes. RESULTS: The pain scores (especially for arm pain) were decreased significantly in both groups after surgery regardless of the type of operation technique (P<0.05). There were no significant differences between both groups at the disc height measurements of operated levels in postoperative periods (P>0.05). In addition to these; there was no significant difference between both groups of segmental and cervical lordodic angles in postoperative periods (P>0.05). There was no statistically significant difference between the fusion rates and pain scores of both groups (P>0.05). CONCLUSION: The PEEK cage and bladed PEEK cages can be used safely to obtain fusion after ACD.Öğe Congenital defect of the anterior arch of the atlas: A case report and review of the literature(Medknow Publications & Media Pvt Ltd, 2014) Karavelioglu, Ergun; Kacar, Emre; Karavelioglu, Afra; Gonul, Yucel; Guven, Mustafa[Anstract Not Available]Öğe Does Glp-2 have a protective effect on cerebral ischemia/reperfusion model?(Tubitak Scientific & Technological Research Council Turkey, 2015) Topaloglu, Naci; Memi, Gulsun; Kaner, Tuncay; Deniz, Mustafa; Sahin, Onder; Guven, Mustafa; Cosar, MuratBackground/aim: To investigate the neuroprotective effects of glucagon-like peptide 2 (Glp-2), which increases cerebral blood flow, on the hippocampal complex after cerebral ischemia/reperfusion (I/R) injury in rats. Materials and methods: Animals were randomized into 4 groups: sham, I/R + 0.9% NaCl, I/R + pre-Glp-2, and I/R + post-Glp-2. Cerebral ischemia was performed via the occlusion of the bilateral internal carotid artery for 40 min and continued with a reperfusion process. At the end of 6 h of reperfusion, animals were decapitated in all groups and brain tissues were removed. Malondialdehyde (MDA) and natural intracellular antioxidant glutathione (GSH) levels and myeloperoxidase (MPO) activities were measured in the left hippocampal tissue. The right hippocampal tissues of all group members were taken for histopathologic study. Results: MDA levels and MPO activities increased from Group I to Group II and decreased from Group II to Groups III and IV. On the other hand, GSH levels were not significantly different among the groups. The number of apoptotic hippocampal tissue cells increased from Group I to Group II and decreased from Group II to Groups III and IV. Conclusion: Our preliminary study revealed that Glp-2 treatment may decrease oxidative damage from I/R in cerebral tissue.Öğe Effect of Using High-Speed Drill in Anterior Cervical Discectomy and Fusion(Turkish Neurosurgical Soc, 2016) Guven, Mustafa; Ceylan, Davut; Aras, Adem Bozkurt; Akbal, Ayla; Gokmen, Ferhat; Resorlu, Hatice; Alkan, BahadirAIM: The objective of this study was to investigate the effect of using 2 different surgical techniques (curette or high-speed drill) in anterior cervical discectomy surgery on the healing of cases. MATERIAL and METHODS: Fifty-four operated cervical disc hernia cases were retrospectively examined in 2 groups. Discectomy and osteophytectomy were carried out in Group A by using a high-speed drill, while a curette was used for group B. Preoperative and postoperative computerized tomography and direct radiography were performed. Cervical disc height, cervical and segmental lordotic angles were calculated. The visual analogue scale and Odom's criteria were used in the assessment of pain and clinical healing. The fusion ratio of both groups was compared. The Mann-Whitney U test was used to compare data from the groups. RESULTS: Satisfactory results were obtained in the groups where high-speed drill and curette were used. Independently from the surgical technique, pain scores were significantly reduced in both groups after surgery. No radiologically significant differences were identified between the two groups within the postoperative period. CONCLUSION: Either high-speed drill or curette can be chosen for the osteophytectomy and discectomy stages of anterior cervical discectomy operations.Öğe Effects of Aloe Vera on Spinal Cord Ischemia-Reperfusion Injury of Rats(Taylor & Francis Inc, 2016) Yuksel, Yasemin; Guven, Mustafa; Kaymaz, Burak; Sehitoglu, Muserref Hilal; Aras, Adem Bozkurt; Akman, Tarik; Tosun, MuratAim: The purpose of this study was to evaluate the possible protective/therapeutic effects of aloe vera (AV) on ischemia-reperfusion injury (I/R) of spinal cord in rats. Materials and Methods: A total of 28 Wistar Albino rats were divided into four random groups of equal number (n = 7). Group I (control) had no medication or surgery; Group II underwent spinal cord ischemia and was given no medication; Group III was administered AV by gastric gavage for 30days as pre-treatment; Group IV was administered single dose intraperitoneal methylprednisolone (MP) after the ischemia. Nuclear respiratory factor-1 (NRF1), malondialdehyde (MDA) and superoxide dismutase (SOD) levels were evaluated. Tissue samples were examined histopathologically and neuronal nitric oxide synthase (nNOS) and nuclear factor-kappa B (NF-B) protein expressions were assessed by immunohistochemical staining. Results: NRF1 and SOD levels of ischemia group were found to be lower compared to the other groups. MDA levels significantly increased after I/R. Treatment with AV and MP resulted in reduced MDA levels and also alleviated hemorrhage, edema, inflammatory cell migration and neurons were partially protected from ischemic injury. When AV treatment was compared with MP, there was no statistical difference between them in terms of reduction of neuronal damage. I/R injury increased NF-B and nNOS expressions. AV and MP treatments decreased NF-B and nNOS expressions.Conclusions: It was observed that aloe vera attenuated neuronal damage histopathologically and biochemically as pretreatment. Further studies may provide more evidence to determine the additional role of aloe vera in spinal cord ischemia reperfusion injury.Öğe Effects of Boric Acid on Fracture Healing: An Experimental Study(Humana Press Inc, 2015) Golge, Umut Hatay; Kaymaz, Burak; Arpaci, Rabia; Komurcu, Erkam; Goksel, Ferdi; Guven, Mustafa; Guzel, YunusBoric acid (BA) has positive effects on bone tissue. In this study, the effects of BA on fracture healing were evaluated in an animal model. Standard closed femoral shaft fractures were created in 40 male Sprague-Dawley rats under general anesthesia. The rats were allocated into five groups (n= 8 each): group 1, control with no BA; groups 2 and 3, oral BA at doses of 4 and 8 mg/kg/day, respectively; group 4, local BA (8 mg/kg); and group 5, both oral and local BA (8 mg/kg/day orally and 8 mg/kg locally). After closed fracture creation, the fracture line was opened with a mini-incision, and BA was locally administered to the fracture area in groups 4 and 5. In groups 2, 3, and 5, BA was administered by gastric gavage daily until sacrifice. The rats were evaluated by clinical, radiological, and histological examinations. The control group (group 1) significantly differed from the local BA-exposed groups (groups 4 and 5) in the clinical evaluation. Front-rear and lateral radiographs revealed significant differences between the local BA-exposed groups and the control and other groups (p< 0.05). Clinical and radiological evaluations demonstrated adequate agreement between observers. The average histological scores significantly differed across groups (p= 0.007) and were significantly higher in groups 4 and 5 which were the local BA (8 mg/kg) and both oral and local BA (8 mg/kg/day orally and 8 mg/kg locally), respectively, compared to the controls. This study suggests that BA may be useful in fracture healing. Further research is required to demonstrate the most effective local dosage and possible use of BA-coated implants.Öğe Effects of Tannic Acid on the Ischemic Brain Tissue of Rats(Springer/Plenum Publishers, 2015) Sen, Halil Murat; Ozkan, Adile; Guven, Mustafa; Akman, Tarik; Aras, Adem Bozkurt; Sehitoglu, Ibrahim; Alacam, HasanMany studies of brain ischemia have shown the role played by massive ischemia-induced production of reactive oxygen species, the main mechanism of neuronal death. However, currently, there is no treatment choice to prevent cell death triggered by reactive oxygen species. In our study, we researched the effects of tannic acid, an antioxidant, on the ischemic tissue of rats with induced middle cerebral artery occlusion. The animals were divided into three groups of eight animals. The sham group were only administered 10 % ethanol intraperitoneally, the second group had middle cerebral artery occlusion induced and were given 10 % ethanol intraperitoneally, while the third group had middle cerebral artery occlusion with 10 mg/kg dose tannic acid dissolved in 10 % ethanol administered within half an hour intraperitoneally. The rats were sacrificed 24 h later, and brain tissue was examined biochemically and histopathologically. Biochemical evaluation of brain tissue found that comparing the ischemic group with no treatment with the tannic acid-treated ischemia group; the superoxide dismutase (SOD) levels were higher, malondialdehyde (MDA) levels were lower, and nuclear respiratory factor-1 (NRF-1) was higher in the tannic acid-treated group. Histopathological examination showed that the histopathological results of the tannic acid group were better than the group not given tannic acid. Biochemical and histopathological results showed that tannic acid administration had an antioxidant effect on the negative effects of ischemia in brain tissue.Öğe Evaluation of the Association Between Matrix Metalloproteinase 11 and Intervertebral Disc Disease(Turkish Neurosurgical Soc, 2016) Aras, Adem Bozkurt; Guven, Mustafa; Balak, Naci; Ayan, Erdogan; Uyar, Suheyla Bozkurt; Elmaci, IlhanAIM: The intervertebral disc starts to degenerate when a human being begins to stand and learn to walk. It is known that many extrinsic, intrinsic and genetic factors play a role in disc degeneration. In this study, we examined whether the matrix metalloproteinase 11 might be associated with intervertebral disc degeneration. MATERIAL and METHODS: Fifty-six patients with lumbar disc herniations who were operated at Gortepe Education and Research Hospital, Neurosurgery Clinic between September 2008 and December 2009 were prospectively reviewed. History and complaints were obtained from the case reports. Neuroradiological evaluation was performed with magnetic resonance imaging. Surgical findings of cases were reported in the operation notes. Microscopic posterior hemipartial laminectomy and discectomy were performed in all cases. Degenerated herniated disc material of all cases extracted during surgery was evaluated with immunohistochemical staining in Marmara University, Institute of Neurological Sciences, Pathology Laboratory. RESULTS: Comparing the immunohistochemical staining of cases who were 50 years or younger and cases who were over 50 years old, statistical significance was determined. CONCLUSION: Matrix metalloproteinase 11 has a role in degenerating intervertebral disc disease, but it is not the only factor. Matrix metalloproteinase 11 might be a genetic factor in young-middle aged patients.Öğe Genistein Exerts Neuroprotective Effect on Focal Cerebral Ischemia Injury in Rats(Springer/Plenum Publishers, 2015) Aras, Adem Bozkurt; Guven, Mustafa; Akman, Tarik; Alacam, Hasan; Kalkan, Yildiray; Sılan, Coşkun; Cosar, MuratBrain ischemia and treatment are one of the important topics in neurological science. Free oxygen radicals and inflammation formed after ischemia are accepted as the most important causes of damage. Currently, there are studies on many chemopreventive agents to prevent cerebral ischemia damage. Our aim is to research the preventive effect of the active ingredient in genistein, previously unstudied, on oxidative damage in cerebral ischemia. Rats were randomly divided into three groups: control group (no medication or surgical procedure), ischemia group, and artery ischemia+genistein group, sacrificed at 24 h after ischemia. The harvested brain tissue from the right hemisphere was investigated histopathologically and for tissue biochemistry. Superoxide dismutase and nuclear respiratory factor 1 values decreased after ischemia and they increased after genistein treatment, while increased malondialdehyde levels after ischemia reduced after treatment. Apoptosis-related cysteine peptidase caspase-3 and caspase-9 values increased after ischemia, but reduced after treatment. Our study revealed that genistein treatment in cerebral ischemia reduced oxidative stress and neuronal degeneration. We believe that genistein treatment may be an alternative treatment method.Öğe In a Cerebral Palsy Patient During Finger Amputation Given the Nitrous Oxide After Occuring Pneumocephalus(Derman Medical Publ, 2014) Akman, Tarik; Guven, Mustafa; Aras, Adem Bozkurt; Akman, Canan; Cosar, MuratRanked among the causes of the cranial cavity Pneumocephalus defined as the presence of air trauma, tumors, infections, congenital anomalies cranium, iatrogenic factors, lumbar puncture, post operative cranial or spinal surgery, also can develop after epidural or spinal anesthesia such as Nitrous oxide anesthesia. In this present case because of the headaches in patients with Cerebral Palsy control cranial CT shot after we aim to provide incidentally captured rarely ethiology in pneumocephalus.Öğe Increased Expression of Matrix Metalloproteinases in Ligamentum Flavum Hypertrophy of the Patients with Lumbar Spinal Stenosis(Kamla-Raj Enterprises, 2016) Eser, Betul; Eser, Olcay; Simsek, Nejdet; Bulbul, Erdogan; Guven, MustafaThis paper shows an investigation of the expressions of MMP-3,-13 and their polymorphisms in patients with lumbar spinal stenosis (LSS). Hypertrophied LF tissues and peripheral bloods were obtained from 50 patients with LSS. The expressions of MMP-3,-13 and their polymorphisms were analyzed. No relationship was found between thickness of LFs and MMP-3,-13 genotypes. LF tissues were divided to three groups as grade 1, 2 and 3. Rich elastic fibrils were observed in grade 1. Elastic fibers and elastin/collagen rates decreased in grade 2-3 and 4, and collagen fibers increased and presented a cystic degeneration. MMP-3 immunopositive cells were higher than MMP-13. A correlation between LF thicknesses and MMP-3 was detected. Both MMP-3, -13 were expressed (MMP-3 in higher quantities) in high grade hypertrophied LF. The researchers expect that this paper would provide a better understanding of the pathogenesis of LF hypertrophy and lead to therapeutic alternatives for LSS patients.Öğe Lumbar magnetic resonance imaging findings in Guillain-Barre syndrome(Elsevier Science Inc, 2016) Resorlu, Mustafa; Guven, Mustafa; Aylanc, Hakan; Karatag, Ozan[Anstract Not Available]Öğe Management of Type II Odontoid Fractures for Osteoporotic Bone Structure: Preliminary Report(Turkish Neurosurgical Soc, 2015) Cosar, Murat; Ozer, A. Fahir; Alkan, Bahadir; Guven, Mustafa; Akman, Tarik; Aras, Adem Bozkurt; Ceylan, DavutAIM: Anterior transodontoid screw fixation technique is generally chosen for the management of type II odontoid fractures. The nonunion of type II odontoid fractures is still a major problem especially in elderly and osteoporotic patients. Eleven osteoporotic type II odontoid fracured patients were presented in this article. MATERIAL and METHODS: We have divided 11 patients in two groups as classical and Ozer's technique.We have also compared (radiologically and clinically) the classical anterior transodontoid screw fixation (group II: 6 cases) and Ozer's transodontoid screw fixation technique (group I: 5 cases) retrospectively. RESULTS: There was no difference regaring the clinical features of the groups. However, the radiological results showed 100% fusion for Ozer's screw fixation technique and 83% fusion for the classical screw fixation technique. CONCLUSION; In conclusion, we suggest that Ozer's technique may help to increase the fusion capacity for osteoporotic type II odontoid fractures.Öğe Neuroprotective Effect of Humic Acid on Focal Cerebral Ischemia Injury: an Experimental Study in Rats(Springer/Plenum Publishers, 2015) Ozkan, Adile; Sen, Halil Murat; Sehitoglu, Ibrahim; Alacam, Hasan; Guven, Mustafa; Aras, Adem Bozkurt; Akman, TarikStroke is still a major cause of death and permanent neurological disability. As humic acids are well-known antioxidant molecules, the purpose of this study was to investigate the potential neuroprotective effects of humic acid in a focal cerebral ischemia model. Twenty-four rats were divided equally into three groups. A middle cerebral artery occlusion model was performed in this study where control (group II) and humic acid (group III) were administered intraperitoneally following an ischemic experimental procedure. Group I was evaluated as sham. Malondialdehyde (MDA), superoxide dismutase (SOD), and nuclear respiratory factor-1 (NRF-1) levels were analyzed biochemically on the right side of the ischemic cerebral hemisphere, while ischemic histopathological studies were completed on the left side to investigate the antioxidant status. Biochemical results showed that SOD and NRF-1 levels were significantly increased in the humic acid group (III) compared with the control group (II) while MDA levels were significantly decreased. On histopathological examination, cerebral edema, vacuolization, degeneration, and destruction of neural elements were decreased in the humic acid group (III) compared with the control group (II). Cerebral ischemia was attenuated by humic acid administration. These observations indicate that humic acid may have potential as a therapeutic agent in cerebral ischemia by preventing oxidative stress.Öğe Neuroprotective effect of p-coumaric acid in rat model of embolic cerebral ischemia(Mashhad Univ Med Sciences, 2015) Guven, Mustafa; Aras, Adem Bozkurt; Akman, Tarik; Sen, Halil Murat; Ozkan, Adile; Salis, Osman; Sehitoglu, IbrahimObjective(s): Stroke poses a crucial risk for mortality and morbidity. Our study aimed to investigate the effect of p-coumaric acid on focal cerebral ischemia in rats. Material and Methods: Rats were randomly divided into four groups, namely Group I (control rats), Group II (ischemia rats), Group III (6 hr ischemia + p-coumaric acid rats) and Group IV (24 hr ischemia + p-coumaric acid rats). Cerebral ischemia was induced via intraluminal monofilament occlusion model. In all groups, the brain was removed after the procedure and rats were sacrificed. Malondialdehyde, superoxide dismutase and nuclear respiratory factor-1 were measured in the ischemic hemisphere. The histopathological changes were observed in the right hemisphere within the samples. Functional assessment was performed for neurological deficit scores. Results: Following the treatment, biochemical factors changed significantly. Histopathologically, it was shown that p-coumaric acid decreased the oxidative damage. The neurological deficit scores of p-coumaric acid-treated rats were significantly improved after cerebral ischemia. Conclusion: Our results showed that p-coumaric acid is a neuroprotective agent on account of its strong anti-oxidant and anti-apoptotic features. Moreover, p-coumaric acid decreased the focal ischemia. Extra effort should be made to introduce p-coumaric acid as a promising therapeutic agent to be utilized for treatment of human cerebral ischemia in the future.Öğe Neuroprotective effects of daidzein on focal cerebral ischemia injury in rats(Shenyang Editorial Dept Neural Regeneration Res, 2015) Aras, Adem Bozkurt; Guven, Mustafa; Akman, Tarik; Ozkan, Adile; Sen, Halil Murat; Duz, Ugur; Kalkan, YildirayDaidzein, a plant extract, has antioxidant activity. It is hypothesized, in this study, that daidzein exhibits neuroprotective effects on cerebral ischemia. Rat models of middle cerebral artery occlusion were intraperitoneally administered daidzein. Biochemical and immunohistochemical tests showed that superoxide dismutase and nuclear respiratory factor 1 expression levels in the brain tissue decreased after ischemia and they increased obviously after daidzein administration; malondialdehyde level and apoptosis-related cysteine peptidase caspase-3 and caspase-9 immunoreactivity in the brain tissue increased after ischemia and they decreased obviously after daidzein administration. Hematoxylin-eosin staining and luxol fast blue staining results showed that intraperitoneal administration of daidzein markedly alleviated neuronal damage in the ischemic brain tissue. These findings suggest that daidzein exhibits neuroprotective effects on ischemic brain tissue by decreasing oxygen free radical production, which validates the aforementioned hypothesis.Öğe Neutrophil-Lymphocyte Ratio Connected to Treatment Options and Inflammation Markers of Ankylosing Spondylitis(Wiley, 2015) Gokmen, Ferhat; Akbal, Ayla; Resorlu, Hatice; Gokmen, Esra; Guven, Mustafa; Aras, Adem Bozkurt; Erbag, GokhanBackgroundIn recent years, white blood cells (WBCs) and their subtypes have been studied in relation to inflammation. The aim of our study was to assess the relationship between neutrophil-lymphocyte ratio (NLR) and ankylosing spondylitis (AS). Materials and methodsWe enrolled a total of 177 patients, 96 AS and 81 healthy controls. Complete blood count, WBC, neutrophil and lymphocyte levels were measured, and the NLR was calculated. In the assessment of AS, we used the erythrocyte sedimentation rate, C-reactive protein (CRP), the Bath Ankylosing Spondylitis Disease Activity Index, and the Bath Ankylosing Spondylitis Functional Index. ResultsIn the present study, 96 AS and 81 healthy individuals were enrolled. The mean age was 43.8 12.9 and 46.5 +/- 11.2 years, respectively. Mean disease duration of AS patients was 6.9 +/- 5.6 years (median = 5, min-max = 1-25). The patients with AS had a higher NLR than the control individuals (mean NLR, 2.24 +/- 1.23 and 1.73 +/- 0.70, respectively, P < 0.001). A statistically significant positive correlation was observed between NLR and CRP (r = 0.322, P = 0.01). The patients receiving antitumor necrosis factor therapy had a lower NLR than the patients receiving nonsteroidal anti-inflammatory drug therapy (mean NLR, 1.71 +/- 0.62 and 2.41 +/- 1.33, respectively, P = 0.02). ConclusionNLR may be seen as a useful marker for demonstrating inflammation together with acute phase reactants such as CRP and in evaluating the effectiveness of anti-TNF- therapy.Öğe Patients with Chiari Malformation Type 2 in VP Shunt Rare Complication(Derman Medical Publ, 2014) Akman, Tarik; Guven, Mustafa; Aras, Adem Bozkurt; Cikman, Oztekin; Safak, Ozbey; Karaaslan, Oznur; Akman, CananSpontaneous perforation of the bowel caused by VP shunt is a very rare complication, and if unnoticed will be fatal. Two years previously our case with Chiari malformation type 2 had revision of the distal end of the VP shunt and also myelomeningocele ends on at the end of the infant period. The case was examined laparoscopically and found to have rare spontaneous intestinal perforation at the transverse colon splenic flexure level, followed by anal prolapse of the peritoneal catheter.
