Naci Balak

Bağcılar Training And Research Hospital, İstanbul, Istanbul, Turkey

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Publications (38)35.2 Total impact

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    ABSTRACT: Aim: 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 herniation who were operated at Göztepe 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 Neurological Sciences of Medicine, 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: In this study it was shown that 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.
    Turkish neurosurgery 12/2014; DOI:10.5137/1019-5149.JTN.12762-14.0 · 0.53 Impact Factor
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    ABSTRACT: Aim. Spontaneous cervical epidural hematoma (SCEH) is defined as an epidural hematoma that does not have an etiological explanation. The most common site for SCEH is cervicothoracic area. Early diagnosis and treatment are important for prognosis and good results. In this paper, we aimed to present a case who complains of sudden weakness on right extremities imitating cerebral stroke and that neuroimaging reveals spontaneous cervical epidural hematoma. Case. A 72-year-old woman was admitted to our hospital with acute neck pain and loss of strength on right extremities. On neurological examination, the patient had right hemiparesis. PT, aPTT, and INRresultswere 50.5, 42.8, and 4.8, respectively. Cranial MRI was in normal limits. Spinal MRI revealed a lesion that extends from C4 to C7 located on the right side and compatible with epidural hematoma. The patient was operated after normalization of INR values. Conclusion. Even though SCEH is a rare condition, it can cause severe morbidity and mortality. Early diagnosis and treatment are quiet important for prognosis. SCEH can easily be mistaken for stroke as with other pathologies and this diagnosis should come to mind especially in patients who have diathesis of bleeding.
    10/2014; 2014. DOI:10.1155/2014/210146
  • Naci Balak
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    ABSTRACT: Purpose. The Sylvian (or lateral) fissure is an important structure that has both pathophysiological and microneurosurgical significance. The aims of this review were to revisit the anatomy of the Sylvian fissure and cistern and its overlying arachnoid membrane, and to review its role in the treatment of various surgical pathological lesions. Methods. For the most part, a PubMed search was used in obtaining English abstracts and full-text references for this article. The criterion for inclusion of an article in the references for this review was that it included materials about the anatomical or the clinical properties of the Sylvian fissure, cistern and arachnoid membrane. The relevant books were also used in obtaining supplementary citations. Results. The review presented the anatomy and disease states associated with the Sylvian fissure. Conclusions. A good knowledge of the anatomy of the Sylvian fissure, cistern and its associated arachnoid mater is crucial in the proper diagnosis and neurosurgical management of various pathological conditions.
    British Journal of Neurosurgery 07/2013; 28(1). DOI:10.3109/02688697.2013.815324 · 0.95 Impact Factor
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    ABSTRACT: INTRODUCTION: The aim of this study is to assess the clinical properties and surgical results of patients diagnosed with spinal schwannomas without neurofibromatosis (NF) properties. PATIENTS AND METHODS: The data obtained from 35 patients who underwent resection of spinal schwannomas were analyzed. All cases with neurofibromas and those with a known diagnosis of NF Type 1 or 2 were excluded. 35 patients underwent surgery for spinal schwannoma at our institution between January 1997 and 2010. The data were gathered retrospectively from medical records and included clinical presentation, tumor location and post-operative complications. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists with histopathological sections in paraffin stained with hematoxylin-eosin. RESULT: We treated 35 (20 males and 15 females) patients with spinal schwannomas. The mean age of the patients was 47.2 (between 13 and 76) years. Of the cases, six schwannomas were located in the cervical spine, four in the thoracic spine, two in cervico-thoracic area, 10 in the thoraco-lumbar area and 13 in the lumbar spine. Two patients had malignant schwannomas that were recurrent. Of the 35 cases, the schwannomas were intradural-extramedullary in 30 cases (86%), intradural-intramedullar in 2 cases (6%), and extradural in 3 cases (9%). CONCLUSION: Spinal schwannomas may occur at any level of the spinal axis and are most frequently intradural-extramedullary. The most common clinical presentation is pain. Most of the spinal schwannomas in non-NF patients can be resected completely without or with minor post-operative deficits. This knowledge may help us to create a strategy for total resection of a spinal schwannomas.
    Neurocirugia (Asturias, Spain) 10/2012; 24(6). DOI:10.1016/j.neucir.2012.01.002 · 0.32 Impact Factor
  • 09/2011; 21(3):157-61. DOI:10.1007/s00062-010-0048-z
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    ABSTRACT: Paragangliomas are rare, usually benign tumors of neural crest origin. They account for only 0.6% of all head and neck tumors. In the craniocervical area, they are more common in the carotid body and tympanico-jugular regions. To the authors' knowledge, a case of paraganglioma in Meckel's cave has not yet been reported in the medical literature. The pathogenesis and natural history of paragangliomas are still not well understood. We present a case of recurrent paraganglioma in Meckel's cave. A 53-year-old woman was diagnosed with trigeminal neuralgia, dysesthesia and hypoesthesia on the left side of the face, hearing disturbance and a history of chronic, persistent temporal headaches. Magnetic resonance imaging (MRI) showed a lesion located in Meckel's cave on the left side, extending to the posterior cranial fossa and compressing the left cerebral peduncle. The lesion was first thought to be a recurrence of an atypical meningioma, as the pathologist described it in the tissue specimen resected 3 years earlier, and a decision for re-operation was made. A lateral suboccipital approach to the lesion was used under neuronavigational guidance. The tumor was removed, and histological examination proved the lesion to be a paraganglioma. Five months later, the follow-up MRI showed local regrowth, which required subsequent surgical intervention. A paraganglioma in Meckel's cave is an uncommon tumor in this location. Although ectopic paragangliomas have been described in the literature, a paraganglioma atypically located in Meckel's cave makes a topographic correlation difficult, mainly because paraganglionic cells are usually not found in Meckel's cave. Another peculiarity of the case is the local recurrence of the tumor in a relatively short time despite an attempted, almost gross total resection.
    Surgical Neurology International 04/2011; 2:45. DOI:10.4103/2152-7806.79763 · 1.18 Impact Factor
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    Recai Turkoglu · Naci Balak
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    ABSTRACT: An orbital pseudotumor typically presents with periorbital pain, cranial nerve palsies and proptosis. Although visual deterioration is not unexpected in this pathology, its presentation solely with visual loss is unusual. In this short report, we summarize a case of orbital pseudotumor which presented solely with a decrease in visual acuity, and discuss the clinical and radiological findings. This atypical presentation likely resulted from the orbital pseudotumor originating in the optic foramen, leaving the neurovascular structures of the superior orbital fissure untouched initially. In the early clinical period, an orbital pseudotumor may manifest itself solely by visual loss. It should therefore be included in the differential diagnosis of visual pathologies-even in the absence of orbital pain and symptoms related to ocular movements.
    Journal of Clinical Neurology 03/2011; 7(1):50-2. DOI:10.3988/jcn.2011.7.1.50 · 1.81 Impact Factor
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    ABSTRACT: It is well known that the predilective sites of extrinsic tumors (meningiomas, chordomas, etc) are at the skull base and along the calvarium. Although intrinsic tumors or glial tumors have also been seen to have anatomic and functional predilective sites within the central nervous system, these have not been well documented. We conducted this study to investigate if supratentorial astrocytic tumors have a predilection for specifi c gyri. We investigated the clinical and radiological records of 60 successive patients who had been operated on at our institution and had had histologically confi rmed supratentorial astrocytic tumors (36 males, 24 females, mean age: 52 years). Coronal sections were selected from the pre-operative contrast enhanced T1-weighted magnetic resonance imaging (MRI). The labeling of gyral areas for analysis of MRI was done using Yaşargil's method. Additional information obtained from 3-dimensional MRI and surgical fi ndings was taken into account when it was diffi cult to distinguish the specifi c gyrus in which the tumor was located. The middle portions of the frontal gyri, insular gyri and the supramarginal gyrus and its surroundings were among the most common locations for the development of tumors. Interestingly, with the exception of one case, none of the tumors was situated in the precentral or postcentral gyri. It seems that supratentorial astrocytic tumors have a predilection for specifi c gyri and disfavor some other gyri. This cannot be explained simply by the different sizes of the cerebral lobes. A classical lobar concept of cerebral anatomy may lead to a misunderstanding of cerebral pathophysiology.
  • 38th Annual Meeting of the International Society for Pediatric Neurosurgery, Jeju, South Korea, October 31 to November 4, 2010; 10/2010
  • 38th Annual Meeting of the International Society for Pediatric Neurosurgery, Jeju, South Korea, October 31 to November 4, 2010; 10/2010
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    ABSTRACT: For decades, lumbar discectomy has been one of the most common surgical practices performed by neurosurgeons. Although it has proved to be an effective and safe surgical procedure, life threatening complications may occur in rare cases, including iliac artery and/or vein injuries, superior rectal artery injury, common iliac artery aneurysms, iliac arteriovenous fistula, intestinal injuries, and ureteral injuries. Ureteral damage during the lumbar L4-5 microdiscectomy was reported in a slim 50 year-old male patient. Because of a small amount of bleeding occurred during the surgery as soon as the patient came out of anesthesia, an angio-computed tomography (CT) of the abdomen was performed. It showed no hematoma and no major vascular injury, but air bubbles were seen in the retroperitoneal region, indicating that perforation had occurred. The patient was then monitored carefully for immediate and possible subsequent injuries, in this way; ureteral damage was found and repaired. This is perhaps the first such case report in the literature of the early detection of ureteral damage using an angio CT scan. If there is a suspicion of perforation of the anterior annulus fibrosus and anterior longitudinal ligaments but no indication for an emergency laparotomy, an abdominal angio CT done immediately after the surgery and an abdominal non-contrast CT 4 hours later will give sufficient information concerning the potential occurrence of nearly all the major complications associated with lumbar discectomy.
    Journal of neurosurgical sciences 09/2010; 54(3):129-33. · 0.78 Impact Factor
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    ABSTRACT: The Currarino syndrome is a rare triad that is a combination of a presacral mass, a congenital sacral bony abnormality and an anorectal malformation. We present 4 children with complete Currarino triad who were diagnosed using MRI. Our aim was to report the neurosurgical management of Currarino syndrome in children. All of the patients had chronic constipation and pain in the lumbosacral region. In the plain radiograph, 3 patients had a sacral scimitar-shaped bony abnormality, and 1 patient had total sacral agenesis. There was a narrow anal canal or narrow ventrally displaced anus in all patients. Their anorectal malformations were characterized as anal stenoses (4 patients), associated with Hirschsprung's disease in 2 cases. In 3 patients, MRI showed tethered cord syndrome in addition to the presacral mass. There was hydrocephalus in 1 patient. Anal stenosis was treated by anal dilatation. In 2 patients, rectal biopsy and temporary colostomy (2 patients) had been performed previously due to Hirschsprung's disease. We performed a posterior procedure via lumbar and sacral partial laminectomy-laminoplasty and transdural ligation of the neck of the meningocele for anterior sacral meningoceles, or alternatively, tumor excision for other types of presacral lesions. Histopathologically, 3 were cases of anterior sacral meningoceles and 1 was a teratoma. One of them also had a spinal abscess. He required reoperation (twice) and appeared at the time to have improved with medical therapy. All patients improved and stabilized. There were no additional neurological deficits and no recurrence of the presacral mass over the follow-up period (6 years, on average). The family pedigree did not reveal any familial transmission pattern. In cases of Currarino triad, MRI can allow the characterization of the presacral masses. If it is an anterior sacral meningocele or a solid tumor without severe anorectal malformation, it can be managed with posterior lumbar and sacral procedures. Such approaches are performed easily by transdural ligation of the neck of the anterior sacral meningocele or through tumor excision.
    Pediatric Neurosurgery 08/2010; 46(2):110-9. DOI:10.1159/000319007 · 0.50 Impact Factor
  • 22nd Congress of European Society for Pediatric Neurosurgery.; 04/2010
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    ABSTRACT: Quantitative descriptions of the occipital sinus are lacking in the extant medical literature. Posterior fossa duras with the superior sagittal sinus, the inferior and superior petrosal sinuses were dissected and taken out from fresh human cadavers by cutting at the superior sagittal sinus, the marginal sinuses and the petrosal sinuses bilaterally. The length of the occipital sinuses was measured using calipers. A 0.5-cm section of the occipital sinus was cut out at its midpoint and prepared for measurements of the perimeter and diameter using a stereology workstation. The sinuses were also examined qualitatively using a surgical microscope. There was no occipital sinus in 6.6% of total 30 cases. Multiple occipital sinuses were seen in 10%. In one specimen, the sinus seemed incomplete, failing to reach the marginal sinuses. Some specimens gave the impression that more than one occipital sinus was present, nevertheless, careful dissection showed connections. The breadth of the sinus steadily narrowed downward in direction of foramen magnum. The inner wall with many fibrous bridges was tight, except the lateral parts that were easily separated into two dural sheets. The length of the sinus varied from 10 to 37 mm. The inner diameter (feret maximum) varied from 0.33 to 7.06 mm at midpoint. The breadth of the multiple sinuses did not exceed the mean of our series except in one case. The occipital sinus, which is generally ellipsoid in shape, functions in the majority of cases as a thin, single midline sinus. It may have less resistant recesses laterally.
    Clinical Anatomy 03/2010; 23(4):386-93. DOI:10.1002/ca.20947 · 1.16 Impact Factor
  • N. Balak · A. Aras · N. Isik · I. Elmaci
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    ABSTRACT: Pituitary apoplexy is characterized by an abrupt neurological deteriorating condition associated with rapid expansion of the pituitary gland, caused by ischemic necrosis and hemorrhage. Craniopharyngioma may be difficult to distinguish from pituitary apoplexy. In this study, we discuss a case of pituitary apoplexy in a 19-year-old male patient. In our patient, the tumor was confused with a craniopharyngioma because of the suprasellar extension of the tumor on magnetic resonance (MR) images and the hyperintensity in T1-weighted images, the young age of the patient, and the gradually progressive onset of the symptoms. In conclusion, even without a known history of pituitary adenoma or an abrupt onset of the clinical symptoms, the diagnosis of pituitary apoplexy should be considered in a patient with a suprasellar mass hyperintensity in T1-weighted MR images, which may mimic craniopharyngioma.
    Neurochirurgie 12/2009; 55(6):600-602. DOI:10.1016/j.neuchi.2008.05.004 · 0.47 Impact Factor
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    ABSTRACT: Chronic otitis media is a potentially serious disease because of its complications, most of which are common in conjunction with cholesteatomas. There is variance in the terminology used by neurosurgeons, otorhinolaryngologists and neuropathologists. Synonyms for cholesteatoma found in the literature include epidermoid tumor, epidermoid cysts and epithelial inclusion cyst. Intracranial extension of an acquired cholesteatoma is a rarely documented occurrence. A 47-year-old woman who had undergone a right tympanomastoidectomy 20 years previously, presented with a long history of mild headaches that had become progressively more severe over the last 3 years. Clinical and radiological evaluation of the patient raised the suspicion of an intracranial cholesteatoma. A right temporal craniotomy was performed. The mass was completely excised and histopathological study revealed the tumor to be a cholesteatoma. The patient's post-operative recovery was uneventful. Cholesteatomas possess the capacity for eroding bone and can have an insidious onset, but once established, grows relentlessly and destroys neighboring structures. Since a gradual intracranial involvement does not usually cause acute symptoms of increased intracranial pressure, the correct diagnosis may be difficult. Detailed clinical and radiographic studies in particular are diagnostically helpful. Because of the high incidence of delayed recurrence, life-long follow-up is required. The inconsistency in the histopathological classification of intracranial cholesteatomas should be clarified.
    Clinical neuropathology 11/2009; 28(6):440-4. DOI:10.5414/NPP28440 · 1.31 Impact Factor
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    ABSTRACT: In this article, a 9-year-old male patient with a compound depressed skull fracture overlying the superior sagittal sinus and an intracranial stone foreign body is presented. A cerebral penetrating injury caused by a stone is rare. The computed tomography images obtained at standard window widths and window density levels may not reveal a retained stone, which has a chemical structure similar to bone and may not show any artifacts in the computed tomography scans.
    The American journal of forensic medicine and pathology: official publication of the National Association of Medical Examiners 07/2009; 30(2):198-200. DOI:10.1097/PAF.0b013e318187df75 · 0.62 Impact Factor
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    ABSTRACT: It is well known that changes in cerebral hemodynamics occur after traumatic brain injury (TBI). Osmo-regulation in the brain is important for maintaining a constant milieu in the central nervous system. Nevertheless, to our knowledge, early osmolarity changes after minor head injury have not been studied until now. In this study, serum osmolarity was measured in 99 patients with minor head trauma. As a control group, blood samples were drawn from 99 patients who had a minor trauma in an extremity. Serum osmolarity was estimated using a fully automatic biochemical autoanalyzer within the first 3 hours after the trauma. The mean serum osmolarity levels were 286.08+/-10.17 mOsm/L in the study group and 290.94+/-5.65 mOsm/L in the control group (p<0.001). However, after age adjustment between the study and control groups, this statistical significance was found to be valid only for patients over 30 years of age. It was noted that serum osmolarity levels decrease in the first 3 hours following minor head trauma in patients over 30 years of age. Further studies into this area could provide guidance for the management/treatment of elderly patients.
    Journal of Korean Neurosurgical Society 03/2009; 45(3):151-6. DOI:10.3340/jkns.2009.45.3.151 · 0.52 Impact Factor
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    N Balak · A Aras · N Isik · I Elmaci
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    ABSTRACT: Pituitary apoplexy is characterized by an abrupt neurological deteriorating condition associated with rapid expansion of the pituitary gland, caused by ischemic necrosis and hemorrhage. Craniopharyngioma may be difficult to distinguish from pituitary apoplexy. In this study, we discuss a case of pituitary apoplexy in a 19-year-old male patient. In our patient, the tumor was confused with a craniopharyngioma because of the suprasellar extension of the tumor on magnetic resonance (MR) images and the hyperintensity in T1-weighted images, the young age of the patient, and the gradually progressive onset of the symptoms. In conclusion, even without a known history of pituitary adenoma or an abrupt onset of the clinical symptoms, the diagnosis of pituitary apoplexy should be considered in a patient with a suprasellar mass hyperintensity in T1-weighted MR images, which may mimic craniopharyngioma.
    Neurochirurgie 01/2009; 55(6):600-2. · 0.47 Impact Factor
  • N Balak · C Bayindir · E Uzuner
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    ABSTRACT: Our primary aim was to investigate whether there is any association between thickness of the hydatid cyst's wall and size and whether it has any effect on intact removal of the cyst, independent of the surgeons' technique. Sixteen cases of echinococcal hydatid cyst of the central nervous system, operated on between 1991 and 2007 by various surgeons, were examined. Cyst diameter was directly measured on the specimen or calculated on radiological scans. Histological preparations were made identically by cutting 5-microm-thick longitudinal sections from paraffin blocks of formalin-fixed tissue and stained with HE. Wall thickness was measured using a micrometer by the same pathologist blinded to the measurements of cyst diameter. Cyst diameter and wall thickness correlated negatively (the larger the cyst the thinner the cyst wall); however this was not statistically significant. Neither the cyst size nor the wall thickness proved to be statistically significant as a factor having an effect on intact removal of the cyst. In conclusion, the cyst size and wall thickness do not have any effect on the intact removal of hydatid cyst. It seems that the use of appropriate surgical techniques play the most effective role in outcome of hydatid cyst surgery.
    Clinical neuropathology 01/2009; 28(3):203-9. DOI:10.5414/NPP28203 · 1.31 Impact Factor

Publication Stats

109 Citations
35.20 Total Impact Points

Institutions

  • 2012
    • Bağcılar Training And Research Hospital
      İstanbul, Istanbul, Turkey
  • 2007–2011
    • Göztepe Teaching And Research Hospital
      İstanbul, Istanbul, Turkey
  • 2008
    • Istanbul Training and Research Hospital
      İstanbul, Istanbul, Turkey
  • 2007–2008
    • Dr. Sadi Konuk Education and Research Hospital
      İstanbul, Istanbul, Turkey