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    Currarino syndrome: report of five consecutive patients
    (Springer, 2014) Duru, Soner; Karabağlı, Hakan; Türkoğlu, Erhan; Erşahin, Yusuf
    The Currarino syndrome is regarded as a developmental disorder based on its recognized etiological heterogeneity. This syndrome is thought to result from abnormal separation of the neuroectoderm from the endoderm. Our aim was to report the neurosurgical management of Currarino syndrome in children and adults and to describe what clinician could do if the Currarino triad was suspected. We present five cases of Currarino triad who underwent surgical intervention. All patients had sacral bony deformity, anorectal malformations, and anterior sacral meningocele. A 40-year-old-male had chronic constipation. He was incidentally diagnosed with Currarino syndrome. A 19-year-old-female suffered from a slight weakness in lower extremities and urinary incontinence. Her past medical history was remarkable for anal atresia. The other three cases were children. When an anterior sacral meningocele is encountered, Currarino syndrome should be taken into consideration. Although it is rarity, the Currarino syndrome might be one of the causes of chronic constipation. Endoscopic or endoscope-assisted surgery via a posterior sacral route can be feasible for treatment of some of the patients with anterior sacral meningocele. Anterior meningocele pouch associated with Currarino syndrome will regresses over time following transdural ligation of its neck.
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    Successful endoscopic third ventriculostomy in children depends on age and etiology of hydrocephalus: outcome analysis in 51 pediatric patients
    (Springer, 2018) Duru, Soner; Peiro, Jose L.; Oria, Marc; Aydın, Emrah; Subaşı, Canan; Tuncer, Cengiz; Rekate, Harold L.
    Endoscopic third ventriculostomy (ETV) has become the method of choice in the treatment of hydrocephalus. Age and etiology could determine success rates (SR) of ETV. The purpose of this study is to assess these factors in pediatric population. Retrospective study on 51 children with obstructive hydrocephalus that underwent ETV was performed. The patients were divided into three groups per their age at the time of the treatment: < 6, 6-24, and > 24 months of age. All ETV procedures were performed by the same neurosurgeon. Overall SR of ETV was 80% (40/51) for all etiologies and ages. In patients < 6 months of age SR was 56.2% (9/16), while 6-24 months of age was 88.9% (16/18) and > 24 months was 94.1% (16/17) (p = 0.012). The highest SR was obtained on aqueductal stenosis. SR of posthemorrhagic, postinfectious, and spina bifida related hydrocephalus was 60% (3/5), 50% (1/2), and 14.3% (1/7), respectively. While SR rate at the first ETV attempt was 85.3%, it was 76.9% in patients with V-P shunt performed previously (p = 0.000). Factors indicating a potential failure of ETV were young age and etiology such as spina bifida, other than isolated aqueductal stenosis. ETV is the method of choice even in patients with former shunting. Fast healing, distensible skulls, and lower pressure gradient in younger children, all can play a role in ETV failure. Based on our experience, ETV could be the first method of choice for hydrocephalus even in children younger than 6 months of age.
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    The Use of Tissue-Selective Ultrasonic Aspirators in the Surgical Treatment of Brain and Spinal Cord Tumors
    (2019) Tuncer, Cengiz; Polat, Ömer; Duru, Soner
    Aim: Ultrasonic surgical aspirators are surgical instruments operated with high frequencysound waves. The brain and/or spinal cord tumors can be removed safely with minimaldamaging to neurovascular structures by using tissue-selective ultrasonic aspirators. Besidesits benefits to the patient, by shortening the duration of operation, it may also provide costsavings in terms of hospital management. The aim of this study is to evaluate the utility andfeasibility of ultrasonic aspirator in central nervous system tumors.Material and Methods: Forty patients who apply to the Department of Neurosurgery at DuzceUniversity Medical Faculty between March 2013 and September 2017 due to brain or spinalcord tumor and operated for a brain or spinal cord tumor were included. Ultrasonic aspiratorwas used during the operations, and duration of operations were recorded.Results: The total operation time was compared between the groups that their operationsperformed by using ultrasonic aspirator and by not using it. The mean operation time wassignificantly higher in the group performed operations by using ultrasonic aspirator(253.8±87.5, 195.4±48.7, p=0.014). Whereas ultrasonic aspirator usage did not change theduration of operation in patients with glioblastoma (237.8±56.3, 235.5±31.9, p=0.689).Conclusion: Technological instruments, that become a part of surgical treatment, are devicesthat ensure maximum efficiency with minimum damage. However, these devices require priortraining on how to use them. Training of healthcare staff in the use of ultrasonic aspirator isvery important. Further studies are needed following the training of the assistant healthcarestaff in this subject.