Mustafa K Başkaya

University of Wisconsin–Madison, Madison, Wisconsin, United States

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Publications (148)351.18 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The ventromedial prefrontal cortex (vmPFC) plays a key role in modulating emotional responses, yet the precise neural mechanisms underlying this function remain unclear. vmPFC interacts with a number of subcortical structures involved in affective processing, including the amygdala, hypothalamus, periaqueductal gray, ventral striatum, and bed nucleus of stria terminalis (BNST). While a previous study of non-human primates shows that vmPFC lesions reduce BNST activity and anxious behavior, no such causal evidence exists in humans. In this study, we used a novel application of magnetic resonance imaging (MRI) in neurosurgical patients with focal, bilateral vmPFC damage to determine whether vmPFC is indeed critical for modulating BNST function in humans. Relative to neurologically healthy subjects, who exhibited robust rest-state functional connectivity between vmPFC and BNST, the vmPFC lesion patients had significantly lower resting-state perfusion of the right BNST. No such perfusion differences were observed for the amygdala, striatum, hypothalamus, or periaqueductal gray. This study thus provides unique data on the relationship between vmPFC and BNST, suggesting that vmPFC serves to promote BNST activity in humans. This finding is relevant for neural circuitry models of mood and anxiety disorders.
    Cortex 03/2015; 64. DOI:10.1016/j.cortex.2014.11.013 · 6.04 Impact Factor
  • 02/2015; 76(S 01). DOI:10.1055/s-0035-1546670
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    ABSTRACT: The angioarchitectural features of an arteriovenous malformation (AVM) provide key information regarding natural history and treatment planning. Because of rapid filling and vascular overlap, two-dimensional (2D) and three-dimensional (3D) digital subtraction angiography (DSA) are often suboptimal for evaluation of these features. We have developed an algorithm that derives a series of fully time-resolved 3D DSA volumes (four-dimensional (4D) DSA) at up to 30 frames/s from a conventional 3D DSA. The temporal/spatial resolution of 4D reconstructions is significantly higher than that provided by current MR angiography and CT angiography techniques. 4D reconstruction allows viewing of an AVM from any angle at any time during its opacification. This feasibility study investigated the potential of 4D DSA to improve the ability to analyze angioarchitectural features compared with conventional 2D and 3D DSA. 2D, 3D, and 4D DSA reconstructions of angiographic studies of six AVMs were evaluated by three cerebrovascular neurosurgeons and one interventional neuroradiologist. These observers evaluated the ability of each modality to visualize the angioarchitectural features of the AVMs. They also compared the information provided using the combination of 2D and 3D DSA with that provided by a 4D DSA reconstruction. By consensus, 4D DSA provided the best ability to visualize the internal features of the AVM including intranidal aneurysms, fistulae, venous obstructions, and sequence of filling and draining. 2D and 3D images in comparison were limited because of overlap of the vasculature. In this small series, 4D DSA provided better ability to visualize the angioarchitecture of an AVM than conventional methods. Further experience is required to determine the ultimate utility of this technique. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Journal of Neurointerventional Surgery 01/2015; DOI:10.1136/neurintsurg-2014-011534 · 2.50 Impact Factor
  • Ulas Cikla, Kutluay Uluc, Mustafa K Baskaya
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    ABSTRACT: Thrombosed giant intracranial aneurysms usually present with symptoms and signs from their mass effect. Although multiple treatment options are available, direct clip reconstruction with thromboendarterectomy remains the gold standard. Here we present a 66-year-old man with seizure, aphasia and hemiparesis. Work-up revealed a giant partially thrombosed aneurysm of the internal carotid artery bifurcation with surrounding vasogenic edema. He underwent clip reconstruction of the aneurysm via a cranio-orbital approach. Although we prepared for bypass with the radial artery and/or the superficial temporal artery, we were able to clip-reconstruct the aneurysm without bypass. The patient improved upon his pre-morbid state after surgery and made an excellent recovery. The video can be found here: .
    Neurosurgical FOCUS 01/2015; 38(VideoSuppl1):Video20. DOI:10.3171/2015.V1.FOCUS14618 · 2.14 Impact Factor
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    ABSTRACT: Background and Study Aim To enhance the visualization of the intracranial vasculature of cadavers under gross examination with a combination of imaging modalities. Material and Methods A total of 20 cadaver heads were used to test two different perfusion techniques. First, fixed cadaver heads were perfused with water; second, fresh cadavers were perfused with saline and 10% formalin. Subsequently, brains were removed and fixed. The compounds used were silicone rubber, silicone rubber mixed with powdered barium sulfate, and silicone rubber mixed with tantalum dioxide prepared by the first perfusion technique and gelatin mixed with liquid barium prepared with the second technique. Conventional X-ray imaging, computed tomography (CT), dynamic computed tomography (dCT), and postprocessing three-dimensional (3D) images were used to evaluate all the heads. Results Gelatinized barium was better visualized when compared with tantalum dioxide in conventional X-ray images. The blood vessels injected with either tantalum dioxide or gelatinized barium demonstrated a higher enhancement than the surrounding soft tissues with CT or dCT. The quality of the 3D reconstruction of the intracranial vasculature was significantly better in the CT images obtained from the gelatinized barium group. Conclusions Radiologic examinations of the heads injected with gelatinized barium facilitates the 3D understanding of cerebrovascular anatomy as an important tool for neuroanatomy training.
    12/2014; 75(6):435-444. DOI:10.1055/s-0034-1386653
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    Ulaş Cıkla, Alireza Sadighi, Andrew Bauer, Mustafa K Başkaya
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    ABSTRACT: Objective To illustrate a unique instance of Ehlers-Danlos syndrome type VIII (EDS VIII) with blood blister-like aneurysm of the middle cerebral artery. Design This is a single patient case report. Setting University of Wisconsin-Madison Hospital. Participants A 42-year-old woman with diagnosis of EDS VIII presented with a sudden onset severe headache and altered mental status. She was diagnosed with Hunt and Hess grade IV subarachnoid hemorrhage. Angiography demonstrated a blood blister-like aneurysm of the left middle cerebral artery. After an unsuccessful coiling attempt in another facility, the patient was operated on with the intention to perform extracranial to intracranial bypass and trapping of the diseased segment of the artery. Results The patient's neurologic condition remained poor after surgery. On postoperative day 2, her neurologic examination unchanged, and care was withdrawn per the family's request. Conclusions Individuals with EDS VIII may be at risk for catastrophic vascular events.
    12/2014; 75(2):e210-e213. DOI:10.1055/s-0034-1387185
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    ABSTRACT: The aim of this study was to analyze the topographical anatomy of the dorsal spinal cord (SC) in relation to the posterior median septum (PMS). This included the course and variations in the PMS, and its relationship to and distance from other dorsal spinal landmarks. Microsurgical anatomy of the PMS was examined in 12 formalin-fixed adult cadaveric SCs. Surface landmarks such as the dorsal root entry zone (DREZ), the denticulate ligament, the architecture of the leptomeninges and pial vascular distribution were noted. The PMS was examined histologically in all spinal segments. The PMS extended most deeply at spinal segments C7 and S4. This was statistically significant for all spinal segments except C5. The PMS was shallowest at segments T4 and T6, where it was statistically significantly thinner than at any other segment. In 80% of the SCs, small blood vessels were identified that traveled in a rostrocaudal direction in the PMS. The longest distance between the PMS and the DREZ was at the C1–C4 vertebral levels and the shortest distance was at the S5 level. Prevention of deficits following a dorsal midline neurosurgical approach to deep-seated SC lesions requires careful identification of the midline of the cord. The PMS and septum define the midline on the dorsum of the SC and their accurate identification is essential for a safe midline surgical approach. In this anatomical study, we describe the surface anatomy of the dorsal SC and its relationship with the PMS, which can be used to determine a safe entry zone into the SC. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.
    Clinical Anatomy 12/2014; 28(1). DOI:10.1002/ca.22490 · 1.16 Impact Factor
  • Ulaş Cıkla, Christopher Baggott, Mustafa K Başkaya
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    ABSTRACT: Blood blister-like aneurysms (BBAs) pose a significant challenge to neurosurgeons and neuro-interventionalists. These fragile broad-based aneurysms have a propensity to rupture with minimal manipulation during surgical or endovascular explorations because, unlike saccular aneurysms, they lack all layers of the arterial wall. Aneurysm trapping with extracranial-intracranial (EC-IC) bypass is a safe and durable treatment for BBAs. We describe our technique and the guiding principles for surgical bypass and trapping of BBAs of the supraclinoid internal carotid artery (ICA). Treatment of BBAs of the supraclinoid ICA remains difficult. Aneurysm trapping with EC-IC bypass treats BBAs definitively by eliminating the diseased segment of the ICA. We have found the technique and principles described here to be safe and durable in our hands.
    Acta Neurochirurgica 09/2014; 156(11). DOI:10.1007/s00701-014-2212-8 · 1.79 Impact Factor
  • Ulas Cikla, Chiristopher Baggott, Mustafa K. Baskaya
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    ABSTRACT: In adolescents and young adults, ependymomas are the most common intramedullary tumors in the spinal cord.These tumors arise from ependymal cell lining the ventricles and spinal canal. The clinical presentation of intramedullary ependymomas are variable and nonspecific. They usually present with diffuse back or neck pain as a chief complaint. Upper and lower motor neuron deficits, numbness which typically progresses from distal to proximal, are other common symptoms. Gross total resection of ependymomas can achieve long-term tumor control with preservation of function. Here we present a 29-year old man who presented with progressive weakness of the left leg, bowel and bladder incontinence. During surgery, somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) were used and we achieved gross total resection while preserving the spinal cord. The patient made excellent recovery and all of his preoperative deficitis improved completely. He returned to work on postoperative 2-month.
    Turkish neurosurgery 09/2014; 24(5):763-764. DOI:10.5137/1019-5149.JTN.12603-14.0 · 0.53 Impact Factor
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    ABSTRACT: Uncertainty is a ubiquitous feature of our daily lives. Although previous studies have identified a number of neural and peripheral physiological changes associated with uncertainty, there are limited data on the causal mechanisms underlying these responses in humans. In this study, we address this empirical gap through a novel application of fMRI in neurosurgical patients with focal, bilateral ventromedial prefrontal cortex (vmPFC) damage. The fMRI task involved cued anticipation of aversive and neutral picture stimuli; “certain” cues unambiguously indicated the upcoming picture valence, whereas “ambiguous” cues could precede either picture type. Healthy subjects exhibited robust bilateral insula responses to ambiguous cues, and this cue-related insula activity significantly correlated with heart rate variability during the task. By contrast, the vmPFC lesion patients exhibited altered cue-related insula activity and reduced heart rate variability. These findings suggest a role for vmPFC in coordinating neural and physiological responses during anticipation.
    The Journal of Neuroscience : The Official Journal of the Society for Neuroscience 07/2014; 34(31):10394-10401. DOI:10.1523/JNEUROSCI.1446-14.2014 · 6.75 Impact Factor
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    ABSTRACT: The denticulate ligaments (DL), 20 or 21 pairs of meningeal extensions, spread from the lateral aspect of the spinal cord to the internal aspect of the spinal dura mater. The aim of this study is to define the specific relationship of the DL with adjacent axilla of the spinal nerve roots and to investigate the anatomical features of the DLs and their variations. The topographical anatomy of the DLs and their relationships with the adjacent axilla of the spinal nerve roots was examined on 16 formalin-fixed adult cadaveric spinal cords. The distances from the dural attachment of the DL to the axilla of the superior and inferior spinal nerve roots were measured bilaterally at every spinal level. Also the distances from the dural attachment of the DL to the lateral aspect of the spinal cord were measured bilaterally. Cervical DLs showed a triangular shape, while in the thoracic segment the ligament changes the shape to "Y." Also the most caudal DL was identified to be at the L1-2 level. Our study revealed that the distances from the dural attachment of the DL to the superior and inferior spinal nerve root axilla were different at the cervical, upper thoracic and the lower thoracic segments. Both distances to the superior and inferior spinal nerve root axilla were shown to increase from cervical to lower thoracic segments. This study provides a detailed anatomy of the DLs and their relationship with the adjacent spinal nerve root axilla. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.
    Clinical Anatomy 07/2014; 27(5). DOI:10.1002/ca.22292 · 1.16 Impact Factor
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    ABSTRACT: The aim of this study was to better define the microsurgical anatomy of the supra/parasellar region and describe variations of the anterior clinoid process (ACP). MATERIAL and METHODS: Fifteen formalin-fixed cadaver heads and 25 dry skulls were used to define the microsurgical anatomy of the ACP and related structures. The presence of the caroticoclinoid foramen (CaCF) as well as other relevant measurements were all noted. Radiological examination of the CaCF was also demonstrated on dry skulls.
    Turkish neurosurgery 07/2014; 24(4):484-493. DOI:10.5137/1019-5149.JTN.8738-13.1 · 0.53 Impact Factor
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    ABSTRACT: The ventromedial prefrontal cortex is known to play a crucial role in regulating human social and emotional behaviour, yet the precise mechanisms by which it subserves this broad function remain unclear. Whereas previous neuropsychological studies have largely focused on the role of the ventromedial prefrontal cortex in higher-order deliberative processes related to valuation and decision-making, here we test whether ventromedial prefrontal cortex may also be critical for more basic aspects of orienting attention to socially and emotionally meaningful stimuli. Using eye tracking during a test of facial emotion recognition in a sample of lesion patients, we show that bilateral ventromedial prefrontal cortex damage impairs visual attention to the eye regions of faces, particularly for fearful faces. This finding demonstrates a heretofore unrecognized function of the ventromedial prefrontal cortex-the basic attentional process of controlling eye movements to faces expressing emotion.
    Brain 03/2014; DOI:10.1093/brain/awu063 · 10.23 Impact Factor
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    ABSTRACT: Although configurations of the posterior cerebral artery (PCA) and posterior communicating artery (PComA) have been extensively studied, reported rates of adult (AC), fetal (FC) and transitional configurations (TC) vary widely due to techniques used. A histological technique was applied to measure the circumference of the arteries and this was compared with caliper measurements taken from the same arteries. Ninetyfive brains were examined. The external diameters of all precommunicating, postcommunicating PCAs and PComAs were measured under operating microscope with a micrometer caliper. After measurements, all arteries were prepared for histology, sections were stained with Verhoff's elastic technique and the circumferences were measured using the light microscope. In the caliper group, AC was found in 77.2%, FC was found in 17.3% and TC was found in 5.5% of the right hemispheres, while on the left AC was found in 81.7%, FC in 18.3% and no TC was found. In the histology group, AC was found in 78.3% and FC was found in 21.7% of the right, while on the left AC was found in 81.7% and FC was found in 18.3% of cases. No TC was found in any hemisphere. There was no statistical significance between the two groups. Results of the present study reveal several important findings. When the PComA was absent in one hemisphere, the PComA was FC on the contralateral hemisphere. Transitional configuration was found in a very small number of cases in the caliper group compared to previous studies, and no TC was found in the histology group.
    Journal of neurosurgical sciences 03/2014; · 0.78 Impact Factor
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    ABSTRACT: Segments of the spinal cord generally do not correspond to the respective vertebral level and there are many anatomical variations in terms of the segment and the level of vertebra. The aim of this study is to investigate the variations and levels of lumbar and sacral spinal cord segments with reference to the axilla of the T11, T12, and L1 spinal nerve roots and adjacent vertebrae. Morphometric measurements were made on 16 formalin fixed adult cadaveric spinal cords. We observed termination of the spinal cord between the axilla of the L1 and L2 spinal nerve roots in 15 specimens (93.8%). In all cadavers the emergence of the T11, T12, and the L1 spinal nerve roots was at the level of the lower one-third of the same vertebral body. In 15 specimens (93.8%), the beginning of the lumbar spinal cord segment was found to be above the T11 spinal nerve root axilla and corresponded to the upper one-third of the T11 vertebral body. The beginning of the sacral spinal cord segment occurred above the L1 spinal nerve root axilla and corresponded to the upper one-third of the L1 vertebral body. The results of this study showed that when the conus medullaris is located at the L1-L2 level, the beginning of the lumbar spinal cord segment always corresponds to the body of T11 vertebra. This study provides detailed information about the correspondence of the spinal cord segments with reference to the axilla of the spinal nerve roots. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.
    Clinical Anatomy 03/2014; 27(2). DOI:10.1002/ca.22253 · 1.16 Impact Factor
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    ABSTRACT: Background Dysfunction in ventromedial prefrontal cortex (vmPFC) is believed to play a pivotal role in the pathogenesis of mood and anxiety disorders. Leading neurocircuitry models of these disorders propose that hypoactivity in vmPFC engenders disinhibited amygdala activity, and consequently, pathologically elevated levels of negative affect. This model predicts that a selective loss or diminution of vmPFC function would result in heightened amygdala activity. While this prediction has been borne out in rodent lesion and electrophysiological studies using fear conditioning and extinction paradigms, there has not yet been a definitive test of this prediction in humans. Methods In this study, we tested this prediction through a novel use of fMRI in n=4 neurosurgical patients with focal, bilateral vmPFC damage. Results Relative to neurologically healthy comparison subjects, the vmPFC lesion patients exhibited potentiated amygdala responses to aversive images as well as elevated rest-state amygdala functional connectivity. We observed no comparable group differences for activity in other brain regions. Conclusions These results provide unique evidence for the critical role of vmPFC in regulating amygdala activity in humans, and help elucidate the causal neural interactions that underlie mental illness.
    Biological Psychiatry 02/2014; DOI:10.1016/j.biopsych.2014.02.014 · 9.47 Impact Factor
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    ABSTRACT: A 44-year-old male with Aarskog syndrome (AS) presented with subarachnoid hemorrhage secondary to ruptured posterior communicating artery aneurysm. AS, also known as faciogenital dysplasia, is an X-linked, autosomal dominant or autosomal recessive congenital developmental disorder. This syndrome is characterized by short stature in association with a variety of multiple anomalies in musculoskeletal, neurological, and urogenital systems. Cerebrovascular abnormalities such as anomalous cerebral venous drainage, dysplastic internal carotid artery, and basilar artery malformation have been reported to be associated with AS. To our knowledge this represents the first case of a ruptured intracranial aneurysm in a patient with AS.
    01/2014; DOI:10.2176/nmccrj.2014-0022
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    Brain 01/2014; · 10.23 Impact Factor
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    ABSTRACT: Non-aneurysmal spontaneous subarachnoid hemorrhage is characterized by an accumulation of a limited amount of subarachnoid hemorrhage, predominantly around the midbrain, and a lack of blood in the brain parenchyma or ventricular system. It represents 5% of all spontaneous subarachnoid hemorrhage cases. In spite of extensive investigation, understanding of the mechanisms leading to perimesencephalic non-aneurysmal subarachnoid hemorrhage remains incompletely defined. A growing body of evidence has supported a familial predisposition for non-aneurysmal spontaneous subarachnoid hemorrhage. A 39-year-old Caucasian man presented with sudden onset headache associated with diplopia. His computed tomography scan revealed perimesencephalic subarachnoid hemorrhage. A cerebral angiogram showed no apparent source of bleeding. He was treated conservatively and discharged after 1 week without any neurological deficits. The older brother of the first case, a 44-year-old Caucasian man, presented 1.5 years later with acute onset of headache and his computed tomography scan also showed perimesencephalic non-aneurysmal subarachnoid hemorrhage. He was discharged home with normal neurological examination 1 week later. Follow-up angiograms did not reveal any source of bleeding in either patient. We report the cases of two siblings with perimesencephalic non-aneurysmal subarachnoid hemorrhage, which may further suggest a familial predisposition of non-aneurysmal spontaneous subarachnoid hemorrhage and may also point out the possible higher risk of perimesencephalic non-aneurysmal subarachnoid hemorrhage in the first-degree relatives of patients with perimesencephalic non-aneurysmal subarachnoid hemorrhage.
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    Ulaş Cıkla, Gregory C Kujoth, Mustafa K Başkaya
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    ABSTRACT: The retrosigmoid approach is a work-horse approach to the cerebellopontine angle (CPA), providing access from the foremen magnum to the tentorium. Indications for this approach are variable such as resection of meningiomas, acoustic neuromas and epidermoid tumors, treatment of vascular lesions of vertebrobasilar system, vascular decompression of cranial nerves (V, VII, IX, X), cranial nerve neurectomies, and intrinsic lesions of the cerebellum and brainstem. In this video, we demonstrate the use of retrosigmoid craniotomy for resection of a large CPA meningioma, delineating all steps including positioning, mapping. The video can be found here: .
    Neurosurgical FOCUS 01/2014; 36(V1Supplement):1. DOI:10.3171/2014.V1.FOCUS13445 · 2.14 Impact Factor

Publication Stats

2k Citations
351.18 Total Impact Points


  • 1997–2015
    • University of Wisconsin–Madison
      • Department of Neurological Surgery
      Madison, Wisconsin, United States
    • University of Wisconsin - Stout
      Menominee, Wisconsin, United States
  • 2010
    • California Science Center
      Los Ángeles, California, United States
  • 2003–2009
    • University of Miami Miller School of Medicine
      • Department of Neurological Surgery
      Miami, FL, United States
  • 2005–2007
    • University of Miami
      • Department of Medicine
      كورال غيبلز، فلوريدا, Florida, United States
  • 2004
    • George Washington University
      Washington, Washington, D.C., United States
  • 2000–2003
    • Louisiana State University Health Sciences Center Shreveport
      • Department of Neurosurgery
      Shreveport, Louisiana, United States
  • 2001
    • Louisiana State University
      Baton Rouge, Louisiana, United States
  • 1998–2000
    • Louisiana State University in Shreveport
      Shreveport, Louisiana, United States
  • 1995–1996
    • University of Kentucky
      • Department of Surgery
      Lexington, KY, United States
  • 1992–1996
    • Ankara University
      • • Department of Neurosurgery
      • • Faculty of Medicine
      Engüri, Ankara, Turkey