Naci Balak

Publications (14)21.36 Total impact

• Article: Microsurgical management of non-neurofibromatosis spinal schwannoma.

  Murat Altaş, Ajlan Cerçi, Gokalp Silav, Ramazan Sari, Kenan Coşkun, Naci Balak, Nejat Işik, Ilhan Elmaci
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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; · 0.54 Impact Factor
• Source

  Available from: PubMed Central

  Article: Atypical presentation of orbital pseudotumor with visual loss as an initial manifestation.

  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. · 1.69 Impact Factor
• Article: Recurrent paraganglioma of Meckel's cave: Case report and a review of anatomic origin of paragangliomas.

  Anna Prajsnar, Naci Balak, Gerhard F Walter, Alexandru C Stan, Wolfgang Deinsberger, Leyla Tapul, Cicek Bayindir
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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. 01/2011; 2:45.
• Article: Currarino triad: surgical management and follow-up results of four [correction of three] cases.

  Nejat Isik, Ilhan Elmaci, Bekir Gokben, Naci Balak, Nadir Tosyali
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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. · 0.70 Impact Factor
• Article: Microsurgical and histomorphometric study of the occipital sinus: quantitative measurements using a novel approach of stereology.

  Naci Balak, Gökhan Ersoy, Unal Uslu, Necmettin Tanriöver, Leyla Tapul, Gürsel Cetin, Nejat Işik, Ilhan Elmaci
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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. · 1.29 Impact Factor
• Article: Intracranial retained stone after depressed skull fracture: problems in the initial diagnosis.

  Naci Balak, Belma Aslan, Alpay Serefhan, Ilhan Elmaci
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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. · 0.71 Impact Factor
• Article: Does serum osmolarity change as a result of the reflex neuroprotective mechanism of cerebral osmo-regulation after minor head trauma?

  Naci Balak, Nilgün Isiksacan, Recai Turkoglu
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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. · 0.60 Impact Factor
• Source

  Available from: journalagent.com

  Article: A prospective and comparative study of referrals to neurosurgeons in an emergency department: does use of guidelines for head trauma affect the assessment made by non-neurosurgeons?

  Naci Balak
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  ABSTRACT: Restriction of the direct admission of all head-injured patients to the neurosurgical unit remains common practice in many parts of the world. This study was conducted to assess if the initial neurological examination of patients with a head trauma and their management are adequately performed before the referrals and also to determine whether strict use of guidelines for the management of patients with head injuries can be effective. The referrals of head-injured patients from different doctors in the emergency department to the same neurosurgeon were assessed prospectively in two separate 6-month periods: the period before training of the non-neurosurgeon physicians on the selection of cases that require a neurosurgical intervention and the period after training. The first part of study showed that initial neurological examination of patients with a head trauma and their management were not performed correctly by the non-neurosurgeon physicians. However, the second study period showed that non-neurosurgeon physicians performed a more accurate selection of patients requiring a neurosurgical intervention after receiving systematic neurosurgical training for at least 6 months. In hospitals where there are no specialist trauma surgeons, neurosurgeons should train non-neurosurgeons regarding the accurate selection of neurosurgical cases that need an emergency intervention. In this training, use of guidelines for the management of head injuries is very effective.
  Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 11/2008; 14(4):292-8. · 0.33 Impact Factor
• Article: Pioneering Turkish neurosurgeon Hami Dilek and the traces of Harvey Cushing's legacy in his work.

  Ilhan Elmaci, Naci Balak
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  ABSTRACT: Hami Dilek trained in neurosurgery under Clovis Vincent and Thierry de Martel, pioneers of French neurosurgery who ranked among Harvey Cushing's most loyal admirers. Taking cues from Cushing and the giants of French neurosurgery, Dilek became the first surgeon to practice neurosurgery regularly in Turkey during the 1930s. In 1949, Dilek founded the first independent Turkish department of neurosurgery in Istanbul, and in 1951 he initiated resident training in neurosurgery. Both Cushing and Dilek started out as general surgeons and then became fascinated by the brain and spine. Also, they both single-handedly developed a new specialty where one did not exist before. Further similarities between Dilek and Cushing are also revealed in Dilek's delightful surgical and anatomical drawings. Dilek played an important role in the establishment and development of modern Turkish neurosurgery, and his life story highlights the fact that Cushing's legacy strongly influenced Turkish neurosurgery in the first half of the 20th century.
  Journal of Neurosurgery 05/2008; 108(4):821-9. · 2.96 Impact Factor
• Source

  Available from: Nejat Işik

  Article: The shrinking of an anterior sacral meningocele in time following transdural ligation of its neck in a case of the Currarino triad.

  Nejat Işik, Naci Balak, Atilla Kircelli, Gökhan Göynümer, Ilhan Elmaci
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  ABSTRACT: In this paper we present an adult patient with the Currarino triad, associated with six habitual abortuses and chronic constipation. Our aim is to report the effectiveness of a simple surgical technique in the treatment of anterior sacral meningocele in the Currarino Syndrome. The presentation of the Currarino Syndrome in adulthood is extremely uncommon. We performed a posterior procedure via lumbar and sacral partial laminectomy and transdural ligation of the neck of the meningocele mass. There were no additional neurological deficits and no recurrence of the presacral mass over the 2-year follow up period. When an adult female with habitual abortus and chronic constipation is seen, the possible presence of the Currarino Triad should be investigated and treated. The anterior sacral meningocele in a case of the Currarino Triad regresses over time following transdural ligation of its neck.
  Turkish neurosurgery 02/2008; 18(3):254-8. · 0.62 Impact Factor
• Article: Successful surgical treatment of a hemophiliac infant with nontraumatic acute subdural hematoma.

  Naci Balak, Gōkalp Silav, Yilmaz Kiliç, Cetin Timur, Ilhan Elmaci
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  ABSTRACT: The moderate hemophiliacs usually have no spontaneous bleeding, but bleed after minor or major trauma. The proper management of intracranial hemorrhage in hemophiliac children is a challenge. An 18-month-old male infant with moderate hemophilia A was admitted with fever, vomiting, and hypersomnia. There was no history of trauma or seizure. The CT scans showed an acute subdural hematoma in the right temporoparietooccipital region with midline shift and a coincidental right cerebellar arachnoid cyst. After bolus factor VIII replacement, a right temporoparietal craniotomy was performed, and the subdural hematoma was evacuated. The postoperative CT scans demonstrated no hematoma. The possibility of intracranial hemorrhage in a moderate hemophiliac infant should be considered even if the patient has no history of trauma. The surgical treatment results in a successful outcome in hemophiliac children with subdural hematomas provided that an aggressive factor replacement therapy is initiated before surgery.
  Surgical Neurology 12/2007; 68(5):537-40; discussion 540. · 1.67 Impact Factor
• Article: Unilateral partial hemilaminectomy in the removal of a large spinal ependymoma.

  Naci Balak
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  ABSTRACT: Although the hemilaminectomy technique is known to neurosurgeons performing spinal surgery, laminectomy traditionally has been used during spinal canal surgery for extirpation of spinal cord tumors. Although the technique of unilateral partial hemilaminectomy is familiar in its various permutations to surgeons, its application in the spinal tumor surgery has been rarely reported. The aim of this study was to review the literature about the management of spinal cord ependymomas and to discuss the major controversies in treatment. Case report. A 52-year-old man. The 52-year-old man complained of backache and leg pain bilaterally, dominant on the left side. Spinal magnetic resonance images revealed an intradural mass at the T12-L2 level. A left unilateral hemilaminectomy of the T12-L1 and L2 was performed with the help of high-speed air drills under microscopic magnification and a midline incision was made on the dura. The tumor was totally removed. By using microsurgical techniques and with the help of high-speed drills, a unilateral approach to the intramedullary tumors proved itself to be a safe and easy method in this case. It protected the posterior supporting elements and also permitted the surgeon to manipulate the intradural contralateral side easily. The only difficulty during the operation was the suturing of the dural sac. This case report emphasizes the need to consider the hemilaminectomy technique in spinal tumor surgery.
  The Spine Journal 09/2007; 8(6):1030-6. · 3.29 Impact Factor
• Article: Nocardial cerebral abscess associated with mycetoma, pneumonia, and membranoproliferative glomerulonephritis.

  Ilhan Elmaci, Durmus Senday, Gökalp Silav, Figen Ekenel, Naci Balak, Erdogan Ayan, Murat Akinci, Nejat Isik, Saadet Yazici
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  ABSTRACT: Nocardial brain abscesses remain a clinical challenge. We successfully treated a patient with nocardial brain abscess, mycetoma, pneumonia, and glomerulonephritis. Nocardial soft tissue involvement, mycetoma, is well known. However, the fact that actinomycetoma can metastasize may not be as well appreciated. The association between nocardiosis and glomerulonephritis should be better clarified.
  Journal of Clinical Microbiology 07/2007; 45(6):2072-4. · 4.15 Impact Factor
• Article: Microsurgery in the removal of a large cerebral hydatid cyst: technical case report.

  Naci Balak, Cengiz Cavumirza, Hümeyra Yildirim, Seçil Ozdemir, Demet Kinay
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  ABSTRACT: Surgery is presently the mainstay in the treatment of cerebral hydatid cysts, but removal without perforation of the cyst wall is critical. The Dowling-Orlando technique has been the main surgical choice for the intact removal of intracranial hydatid cysts. Dowling described his technique in 1929, well before the introduction of the microscope in neurosurgery. Using the operating microscope has not been reported in the removal of a large hydatid cyst. The case of a 16-year-old male with a large, right parieto-occipital hydatid cyst is presented. In this case, surgery was greatly aided by the use of the microscope in the initial stage of the removal of the cyst. Cyst extraction during the delivery process was continued without the aid of the microscope. The cyst was successfully removed intact. The use of the magnification during the early part of the surgery of a hydatid cyst is extremely helpful because, at a crucial stage of the procedure, it prevents inadvertent damage of the very thin cyst wall and allows development of the critical surgical plane.
  Neurosurgery 11/2006; 59(4 Suppl 2):ONSE486; discussion ONSE486. · 2.79 Impact Factor