Areas of expertise

You can compare the pre- and post-operative images by sliding the slider in the middle of the images.

Lumbar Disc Herniations

Our lower back is a structure that carries the weight of our body, transfers the load from the hips to the legs, and also enables our body to be active in our daily activities. Lumbar disc herniation is the definition given to all painful conditions that occur as a result of the displacement of the structure called disc, located between the vertebrae of the lumbar region, towards the canal through which the nerves and spinal cord pass. The discal structure, which acts as a support between the bone structures called “vertebrae”, which forms the basic skeletal structure of the body in the lower back, and which minimizes friction in movements, may degenerate over time, or may be displaced due to reverse movements, heavy lifting and similar reasons. Nerves that leave between the two vertebrae and travel especially towards the legs may be under pressure due to the displacement of this discal herniation. As a result, problems such as pain, numbness and weakness in the legs may occur. In advanced stages, even sudden urinary incontinence problems may occur.

Surgical indication can be made when there is a clear correlation between the patient’s radiological examinations, examination findings and complaints. In cases where pain control cannot be achieved despite 5-8 weeks of medical treatment, or in patients who do not want to waste time with medical treatment, surgical treatment can be applied. The gold standard in treatment is microdiscectomy. The aim is to clean the cartilage tissue that crushes the nerve. A small incision is made through the skin, the hernia is cleaned and the nerve is relieved.

The success rate of surgery is 90%. However, there are points that the patient with herniated disc should pay attention to while continuing his or her daily life after the surgery. First of all, the patient should not gain weight. Exercising is also beneficial. When picking up an object from the ground, the patient should not be bent at the waist, but by crouching. When these points are observed, the probability of recurrence of the disease is very low.

You can compare the pre- and post-operative images by sliding the slider in the middle of the images.

Cervical Disc Herniations

The neck has the ability to move our head in all directions and has a structure that carries the weight of the head. There are 7 vertebrae in the neck region. omurgayı Between the vertebrae is the cartilage tissue called the disc, which starts between the second and third vertebrae. Neck hernia occurs when the disc contents overflow outward as a result of the weakening of the disc between the bones forming the spine. As a result of herniation, exiting nerves from the spinal cord may be compressed or even the spinal cord itself. With nerve root compression, severe and burning pain, numbness, tingling that spreads to the arm and hand, and muscle weakness in the hand or arm can be seen in advanced cases.

The most common cause of neck pain is “mechanical neck pain”. This pain gradually decreases within 2-3 days and disappears within 1-2 weeks. Sometimes the pain can become chronic and intensify during acute attacks. In this case, it is useful to consult a doctor to be evaluated in terms of cervical disc herniation. Severe pain in the arm due to the pressure on the nerve root is the most important symptom of cervical disc herniation. Surgery may be considered for chronic pain or severe pain that is unbearable despite painkillers. In some patients, loss of strength develops due to pressure on the nerve root. The development of loss of strength requires surgery to remove the pressure on the nerve. Spontaneous relief of pain does not mean that the disease has disappeared.

Removing the pressure on the spinal cord and nerves is the primary goal in surgical treatment. The herniated disc is removed in the surgery, which is usually performed on the anterior-right side of the neck (rarely, it can be done from the back of the neck) using microsurgical technique. Thus, symptoms such as numbness, loss of strength and pain are eliminated. After cervical discectomy surgery, which lasts for one hour, under general anesthesia, the patient returns to his or her normal life within 15 days.

You can compare the pre- and post-operative images by sliding the slider in the middle of the images.

Degenerative Spine and Listhesis

                The canal through which the spinal cord and nerves exiting the spinal cord travel within the vertebral bones is called the “spinal canal”. As a result of many factors such as trauma, chronic misuse, genetic factors, thickening and coarsening of the soft tissue and bone structures that make up the spinal canal can cause narrowing in this canal. As a result, compression occurs in the nerve roots. These patients complain of pain and numbness in the calf, especially when standing for a long time and walking. When they sit and lean forward, the pain symptoms are relieved. If a vertebral body moves over another vertebral body causing a pressure on the nerve roots, in addition to low back pain, pain, weakness and numbness may occur in the thigh and leg.

                If there are complaints of weakness in the legs and/or inability to urinate and defecate due to compression on the nerves, if there is instability (abnormal mobility) in the spine, surgical intervention is absolutely necessary. Although there are no neurological findings such as loss of strength, if the quality of life of patients is affected due to prolonged pain, pain alone may be the reason for surgical intervention. While choosing the surgical intervention method, each patient should be evaluated separately and the appropriate technique should be selected for that patient.

                 Surgical intervention aims for the decompression of the calcified structures compressing the spinal canal or roots by reducing the slipped vertebra in its place and stabilizing it. This is achieved by stabilization surgery, popularly known as platinum insertion. These surgeries, which were described as risky in the past years, have become safe and have high rates of success with the developing technology and the x-rays used during the surgery.

Before and after spinal calcification
Omurga kayması öncesi ve sonrası

You can compare the pre- and post-operative images by sliding the slider in the middle of the images.

Spine Tumors and Malignancies

                Tumors made up of cells that make up our spinal system are called spinal or spinal cord tumors. The presence of cancerous cells in the spinal cord, which is an important part of the nervous system and plays a role in the transmission of brain functions to the body, leads to very serious consequences. However, tumors that can be benign or malignant may have spread from another cancerous region to this region, apart from being formed from their own cells. Surgical methods are used in the treatment of tumors in the nervous system and spinal cord, which take part in even the simplest functions, and positive results are obtained.

Although some spinal metastases do not cause a compression of the spinal cord, the pain caused by the malignancy may be so severe that it is not alleviated by medication. In such cases, bone cement can be injected into the vertebrae or vertebrae that cause pain, by closed surgery with the methods we call “Vertebroplasty” and “Kyphoplasty”. These methods can be helpful both in reducing pain and in supporting the strength of the bone. Surgery for tumors that are right inside the spinal cord is a little more critical. With the developments in microsurgery and a device called “Neuromonitorization” that allows the patient’s nerve functions to be followed at the time of surgery, these surgeries are performed with lower risks. In tumors originating from the spinal cord, radiotherapy or chemotherapy can be added to the treatment depending on the grade of the tumor.

You can compare the pre- and post-operative images by sliding the slider in the middle of the images.

Peripheral Nerve Compression

                Uzak (omurilik dışı) sinir sıkışmaları; karıncalanma, ağrı, uyuşma ve diğer belirtilerin neden olduğu sinir tuzaklarıdır. Temel problem ele giden sinirlerin belli tünellerden geçerken çevre kılıflar tarafından sıkıştırılmalarıdır. En sık görülenleri; boyun bölgesinden çıkıp bileğe kadar uzanan medyan ve ulnar sinir sıkışmalarıdır. El ve kolda birçok kasın uyarılmasını üstlenen bu sinirler, kanal boyunca sıkışırlarsa  Karpal Tünel veya Kübital Tünel Sendromu gibi isimlerle anılan hastalıklara neden olurlar.

                Pain medications and physical therapy applications are in the first step of treatment. If the compression is severe and unresponsive to medical treatment, surgical treatment is applied to open the sheath and release the nerve. In surgical intervention, the surgical area is anesthetized with local anesthesia. After the skin and subcutaneous tissues are passed, the thickened ligament forming the front of the tunnel is cut and the nerve is relieved. The intervention takes about 15-20 minutes. The patient is discharged on the same day. The success rate of surgical treatment is very high. The risk of recurrence of the disease is very low.

Brain Tumors

Brain tumors constitute an important group of diseases in neurosurgery. Brain tumors may arise from the tissues normally found within the skull or are formed by cancer cells that have metastasized to the brain from a cancer in another part of the body. In general, we can classify brain tumors as malignant (malignant) and benign (benign).

In patients with brain tumors, complaints such as headache, vomiting, nausea, visual impairment, impaired consciousness, convulsions, weakness in the arms and legs, irritability, loss of appetite, decreased hearing, forgetfulness, inability to speak and understand, inability to write, imbalance, enlargement of the hands and feet can be seen. Headache (usually more severe in the morning) and seizure are the most common findings.

The patient who presents with the stated complaints is first examined. An MRI is taken so that it can be seen whether there is a mass. The location, size, and features of the tumor in MRI are effective in determining the treatment. Medication, surgery or radiosurgery are used to treat the tumor. In some cases, it may be necessary to use all of them together. Surgical treatment is absolutely necessary for some tumors, whether benign or malignant. However, in some cases, surgery may not be possible. If the tumor is located in some vital areas of the brain that are very sensitive, touching these areas is life-threatening, and the tumor can be left in place. In this case, only radiation therapy and drug therapy (chemotherapy) can be applied.

You can compare the pre- and post-operative images by sliding the slider in the middle of the images.

Pituitary Adenomas

There are two main systems that control the functions of the body. The first of these is the “nervous system” that takes its source from the brain and spinal cord and disperses all over the body, and the second is the “hormonal system” or “endocrine system” that manages body functions by constantly circulating in the blood. These two systems work in conjunction with each other. The organ that we describe as the Pituitary Gland is the center of the hormonal system, and the abnormality that will occur here can upset the entire hormonal system of the body.

Symptoms; Acromegaly in adults, gigantism (giantess) in children and young people, Enlargement in hands, feet and chin, Thickening of the skin, coarsening of the voice, Coarseness in the facial features, Diabetes, Muscle weakness, Increased hair growth, loss of libido, double vision, inability to see the sides, milk coming from the nipple etc. and there may be more.

There are three approaches to the treatment of pituitary tumors: drug therapy, surgery and radiation therapy. It is possible to control excessive hormone secretion with medication. However, when the drug is discontinued, hormone secretion returns to its previous level in most patients. For example, if the patient wants to become pregnant in a tumor that secretes excessive prolactin, the drug should be discontinued as it will have adverse effects on the unborn baby. This facilitates tumor regrowth. The patient may need to use the drug all their life. The aims of surgical treatment are: To remove the pressure of the tumor on the surrounding tissues, such as optic nerves, to reduce the tumor mass and to provide a better response to drug treatment. Tumors that do not respond to medication should also be treated surgically. In cases such as macroadenoma or bleeding into the tumor that cause sudden vision loss, surgery should be performed without delay. Surgical treatment is done in two main ways. The first is through the nasal passage called the transsphenoidal approach. However in cases where multiple recurrences have occurred and has not responded well to adjuvant therapy, or has a large size that has compressed other parts of the brain, transcranial approach may be employed.

Today, the transsphenoidal route is preferred in the surgical treatment of pituitary tumors. It can be done microscopically and endoscopically. After the tumor is cleaned by entering through the nose, symptoms improve.

Hydrocephalus

                Hidrosefali, “beyinde su toplanması” olarak da bilinen, beyin ventriküllerinde ve boşluklarında normalin üzerinde BOS (Beyin Omurilik Sıvısı, Serebrospinal Sıvı) birikmesi durumudur. Bu durum kafatasının içindeki kafa boşluğunda basıncın artmasına ve kafanın artan ölçüde büyümesine, kasılmalara ve zihinsel engelli olma sonuçlarına yol açabilir. Bu terim hidro (su) ve sefali (kafa) terimlerinden türemiştir.

                Symptoms of hydrocephalus vary from person to person and according to age groups: 

In newborns (0-2 months); Overgrowth of the head, thinning of the scalp, prominent veins in the head, vomiting, restlessness, drooping eyes, seizures, or inability to communicate. In children (2 months and above); Abnormal growth of the head, headache, nausea, vomiting, fever, double vision, restlessness, regression in walking or speaking, communication disorder, loss of sensory-motor functions, seizures. Older children may have difficulty staying awake or waking up. In middle-aged adults; Headache, difficulty waking or staying awake, balance disorder, urinary incontinence, personality disorder, dementia, visual impairment may be seen. In the elderly; Disturbance in communication, walking disorders, difficulty in remembering, memory loss, headache, urinary incontinence can be seen.

Hydrocephalus cannot be treated with medication. For this reason, shunt surgery is performed if Hydrocephalus has occurred due to non-tumor reasons. In this surgery performed under general anesthesia, a small hole is made in the skull and the tip of the catheter is placed in the area of the brain where the cerebrospinal fluid is located. Then, a tunnel is opened under the skin and the other end of the catheter which is transferred to the abdominal cavity where the fluid can be absorbed. As long as there is no obstruction or infection in the shunt, a new surgery is not necessary. Shunt surgery gives positive results in most of the patients. Patients who have surgery usually need a lifelong shunt. Therefore, removal is not recommended. The shunt helps the person maintain a normal life.

You can compare the pre- and post-operative images by sliding the slider in the middle of the images.

Traumatic Brain Injury

A head injury is any post-traumatic injury to the skull or brain. The terms traumatic brain injury and head injury are often used interchangeably in the medical literature. Traumatic brain injuries cover a very wide area and can occur for many reasons, such as accidents, falls, physical assaults, or traffic accidents. If there is bleeding that leads to increased intracranial pressure after trauma or to herniation (pressure to vital areas after displacement) in the brain, emergency surgical intervention is required. These types of bleeding are called Subdural or Epidural Hematoma. Subdural hemorrhage is bleeding that occurs between the dura mater and the arachnoid membrane, one of the cerebral membranes surrounding the brain. Epidural hematoma is the name given to the accumulation of a hematoma between the dura mater located on the brain tissue and the skull bone. Findings of subdural hemorrhage occur more slowly than epidural hematomas. The reason for this is that the flow in the veins is slower. In Epidural Hematoma, however, the time between bleeding and death varies, and because the skull is a closed box, arterial bleeding rapidly worsens the situation.

                What is common to both Epidural and Subdural hematom is the presence of a clot mass and the compression of brain tissue. If this clot is not removed, it grows gradually and causes the death of the patient by putting pressure on the brain. Therefore, if there are symptoms after severe head trauma, tomography should be taken. In tomography, it is checked whether there is bleeding or fracture in the bone. Sometimes, when the CT scan is first taken, the bleeding may not be seen completely because it is thin, but if the symptoms start to appear after 4-5 hours, a tomography should be taken again. Persons with severe head trauma should therefore be kept under observation in the hospital for a period of time. In both types of bleeding, the only treatment method is surgery. After the problem is resolved with surgery, the patient can lead a normal life if there is no permanent damage to the brain due to trauma.

You can compare the pre- and post-operative images by sliding the slider in the middle of the images.

Cerebral Aneurysm and ArterioVenous Malformation

                Beyin damarlarında meydana gelen hastalıklar baloncuk (anevrizma) veya bir atardamar-toplardamar yumağı (arterivenöz malformasyon) olarak kendilerini gösterebilirler. Henüz kanamamış bir anevrizma teşhis edilen hastalarda tedavi kararı, hastanın yaşı, anevrizmanın oluşturduğu şikayetler, anevrizmanın morfolojisi (yapısı/görünümü), anevrizmanın yerleşim yeri, anevrizmanın boyutları ve hastaya özel diğer tıbbı şartlar göz önüne alınarak verilir. Anevrizma patlaması sonucu beyin kanaması gelişmiş hastalarda ise, eğer anevrizma tedavi edilmezse (kapatılmazsa), hastaların yaklaşık %35’inde ilk kanamadan sonra, 30 gün içinde anevrizma tekrar patlayarak ikinci bir beyin kanamasına neden olur. Bu nedenle anevrizmaya bağlı beyin kanaması geçiren hastalar, en kısa süre içinde tedavi edilmelidir. AVM’lerin ise genellikle doğuştan olduğu varsayılır ve bir damar anomalisidir. en genel belirtisi başağrısı ve epilepsidir. Bundan başka kas güçsüzlüğü, subaraknoid kanama, uyuşma, halüsinasyon görme, konuşma bozukluğu görülebilir.

                There is an indication for surgical treatment in both vascular pathologies. Advancing a catheter through the vein by angiography and filling the aneurysm with metal crimped wires, ‘coil application’ to block it, surgically closing the neck where it comes out of the vein with a metal clip, removing the AVM with surgery or applying radiosurgery to the AVM; are the current surgical options.