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Öğe Analysis of denver neurodevelopmental screening test results of myelomeningocele, hydrocephalus, and microcephaly patients(Medknow Publications & Media Pvt Ltd, 2018) Alataş, İbrahim; Canaz, Gökhan; Arslan, Gülseren; Çevik, Serdar; Kaçmaz, Belgü; Kara, Nursu; Canaz, HuseyinContext: Spina bifida, hydrocephalus, and similar congenital central nervous system (CNS) anomalies take origin from embryologic stages weeks before birth, but assessment and follow-up of these patients are important to figure and predict the effects of these anomalies on child's neurodevelopment. Aims: To evaluate of multiple groups of congenital CNS anomalies in the neurodevelopment level. Settings and Design: The study was conducted at a research and treatment center for spina bifida patients. Materials and Methods: The study group included 348 patients with a mean age of 15.4 (+/- 15.1) months, who had spina bifida aperta, hydrocephalus, and microcephaly. Patients with other known intracranial conditions were excluded. The subjects were evaluated into five groups: Group 1, 88 patients with congenital hydrocephalus; Group 2, 48 patients with congenital hydrocephalus and ventriculoperitoneal shunt; Group 3, 148 patients with microcephaly; Group 4, 30 patients who were operated for spina bifida aperta; and Group 5, 39 patients who were operated for spina bifida aperta and also had ventriculoperitoneal shunt implantation. Denver Developmental Screening Test II was used to assess patients' neurodevelopment levels. Statistical Analysis Used: Pearson's chi-square and Fisher's exact tests were used for data analysis. Group comparisons were also made in pairs with chi-square test according to Bonferroni corrections. Frequency of abnormal findings was significantly correlated with age (P = 0.014). Results: Total score differences of five groups appeared to be statistically significant according to Pearson's chi-square test (P = 0.000). When we compared groups in pairs, abnormal results were significantly frequent in shunted groups (P < 0.01). Conclusions: Our results suggested that shunt-dependent hydrocephalus caused serious neurodevelopmental impairments in patients.Öğe Does adding TENS to pelvic floor rehabilitation effect on urodynamics and clinical results in children with spina bifida?(John wiley and sons inc, 2025) Özdemir Ayla, Özge; Özel, Şeyhmus Kerem; Acar, Gönül; Alataş, İbrahimIntroduction Children with spina bifida (SB) experience a reduced quality of life due to neurogenic bladder dysfunction and the risk of renal failure later in life. Pelvic floor rehabilitation (PFR) and transcutaneous electrical nerve stimulation (TENS) have gained prominence in recent years due to their positive effects in treating different types of bladder issues in both adults and children. Our study aims to investigate the effects of using these two methods together in children with SB and to delineate their potential value for clinical practice. Materials and Methods Children with neurogenic bladder dysfunction due to SB who admitted to our spina bifida center were enrolled. Those patients, between 5 and 15 years of age, with only neurogenic detrusor overactivity (NDO) were randomly divided into two groups using an online computer application. While only the PFR was applied to Group PFR (n = 14), TENS was used in addition to this therapy in Group PFR + T (n = 14). The PFR sessions included abdominal massage, strength exercises, diaphragmatic breathing exercises, and contracting pelvic floor muscles. TENS was used in a standard fashion as previously described in patients with SB. Before and after treatment, patients' clinical data, dysfunctional voiding symptom score (DVSS), lower urinary tract symptoms, and quality of life scores due to urinary incontinence were evaluated. Urodynamic outcomes such as detrusor pressure, bladder capacity, contractility, and residual urine amount were also evaluated. Results Twenty eight children out of 750 SB patients were enrolled in our center. Children with only NDO due to SB were included in the study (Group PFR, mean age 8.3 +/- + 2.7 years, 10 boys, four girls; Group PFR + T, 7.86 +/- 2.03 years, eight boys, six girls). Treatment duration was 6 weeks (18 sessions). There was a decrease in voiding and lower urinary tract symptoms in both groups regardless of the use of TENS (p < 0.05). Maximum detrusor pressure significantly decreased only in the TENS group after treatment (from 82.143 +/- 58.069 cmH2O to 58.077 +/- 39.872 cmH2O) (p < 0.05). The difference in clinical parameters, quality of life scores and other urodynamic parameters were not found to be significant between groups. Discussion PFR and TENS may be effective in SB with NDO to reduce voiding symptoms, and protect bladder from increased pressures. PFR seems to be a useful conservative approach in patients with NDO, adjunt to standard treatment. Further studies are needed in delineation of a personalized holistic treatment approach in these patients. Conclusion Addition of TENS to standard PFR in NDO may be effective in reducing maximum detrusor pressures, however, it does not seem to specifically contribute for improving incontinence and incontinence-related quality of life.Öğe Evaluation of neurological examination, sep results, mri results, and lesion levels in patients who had been operated for myelomeningocele(Wolters Kluwer Medknow Publications, 2020) Canaz, Gökhan; Canaz, Hüseyin; Tuna Erdoğan, Ezgi; Alataş, İbrahim; Emel, Erhan; Matur, ZelihaObjective: Myelomeningocele is the most severe and the most frequent form of spina bifida. Most of the myelomeningocele patients undergo operations in newborn age. In terms of life quality and rehabilitation, follow-up's of these patients in the growth and development period after the operation is critical. In our study, our aim is to emphasize the correlation of SEP results with MRI results and clinical features of the myelomeningocele patients. Materials and Methods: In our study, we included 36 patients who had undergone myelomeningocele operation and have been followed-up in Istanbul Bilim University Florence Nightingale Hospital, Spina Bifida Research and Treatment Centre. Posterior tibial nerve SEP was performed on each patient and neurological examinations were done in the same session. Results were compared with clinical functional lesion levels, levels of fusion defect and ambulation levels. In order to evaluate SEP results, we used age-related reference values from Boor et al.'s study in 2008. Patients were grouped as normal, unilaterally prolonged, bilaterally prolonged, unilaterally lost, and bilaterally lost. Results: The correlations of posterior tibial nerve SEP results were significant with ambulation levels (r = 0.428, P < 0.01), clinical functional lesion levels (r = 0.477, P < 0.01) and fusion defect levels (r = -0.528 P < 0.05). The lumbar SEP results were only significantly correlated with functional lesion levels (r = 0.443 P < 0.05). Conclusions: Radiological studies are insufficient when evaluating the functionality of the central nervous system. To fully evaluate the functionality and watch the neurological development with accuracy, especially in operated patients, electrophysiological studies should be an indispensable part of myelomeningocele follow-ups.Öğe The Results of Intraoperative Direct Electrical Stimulation of Roots and Placode During Myelomeningocele Repair(2018) Canaz, Hüseyin; Tuna Erdoğan, Ezgi; Alataş, İbrahimINTRODUCTION: The safety of transcranial high current stimulation is controversial in newborns. However, intraoperative direct stimulation techniques are safe and useful methods even for newborns to determine the functional neural tissue and to provide a safer surgery. We routinely use direct nerve stimulation techniques during myelomeningocele closure in our institution unless patient has total paraplegia. In this paper, we analyzed and presented the results of intraoperative direct stimulation of nerves and neural placode in 20 infants with myelomeningocele. METHODS: Intraoperative direct stimulation was performed and electromyography was followed from lower extremity muscles both for triggered and spontaneous activity during myelomeningocele repair. RESULTS: The compound muscle action potentials were correlated with motor examination of lower extremities. While, the level of conduction block in motor pathways involved nerve roots in some cases, most of the stimulated roots were functional which indicates the motor conduction block was upper in spinal cord. In one case dysmorphic appearing rootlet was found functional and preserved throughout the surgery. DISCUSSION and CONCLUSION: In our practice, intraoperative direct stimulation is a useful and reliable method to check the functional neural tissue and spare it to preserve during releasing and closure of neural tube in myelomeningocele operations.Öğe The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele(2018) Canaz, Hüseyin; Tuna Erdoğan, Ezgi; Alataş, İbrahimUsing intraoperative neuromonitoring in both primary and secondary tethered cord operations is accepted as a necessity for a safer operation and guiding surgeon in complex surgeries. METHODS: Twenty four operations which were monitored with three modalities; transcranial motor evoked potentials (TcMEP), free-run electromyography and direct nerve stimulations. In group 1, there were 14 patients underwent tethered cord operations due to occult spinal dysraphism, in group 2 there were 10 patients underwent tethered cord operations secondary to previous myelomeningocele repair. RESULTS: TcMEP responses of lower extremity were elicited in 92 % in group 1, 80 % in group 2. TcMEP responses of anal sphincter were elicited in 83 % in group 1, 60 % in group 2. No TcMEP change was observed during the surgeries in both group. Postoperative urodynamic results of both group were improved in 1 year period (78 % in group 1, 43 % in group 2). In patients with hypoactive bladder, we could not take anal sphincter responses in TcMEP. DISCUSSION and CONCLUSION: Untethering of spinal cord both in asymptomatic occult spinal dysraphism and TCS secondary to MMC, can improve impaired urodynamic results. Intraoperative neuromonitoring and direct stimulation provides information for a safer surgery and guide surgical maneuvers especially in secondary untethering. Intraoperative neurophysiological monitoring is beneficial for operations of MMC patients with neurological deficits, to preserve their residual motor functions. Since anal sphincter functions are correlated with bladder functions, it is possible to get no anal sphincter TcMEP response if patient has hypoactive bladder.Öğe The relationship between urodynamic bladder compliance and urinary fibrosis markers in children with neurogenic bladder dysfunction(Elsevier ltd, 2025) Uğurlu, Deniz; Canmemiş, Arzu; İşman, Ferruh Kemal; Alataş, İbrahim; Ulukaya Durakbaşa, Çiğdem; Özel, Ş. KeremBackground Decreased bladder compliance is an important risk factor for upper urinary tract in children with neurogenic bladder dysfunction (NBD). Urodynamics is the gold standard in determining bladder compliance. Objective To investigate the relationship between low bladder compliance and urinary fibrosis markers in NBD. Study design Spina bifida patients with NBD, who admitted between March 2021 and July 2021 were included. Patients with low compliant bladders, no renal scar, no recurrent urinary tract infections formed low compliance, LC group. Normal compliance, NC group, was comprised of patients with normocompliant bladders and the same characteristics. Control group (Group C) consisted of patients for outpatient surgery and had no known bladder dysfunction. Compliance was calculated with the formula Delta V/Delta P and a value of under 15 ml/cmH2O was accepted as low. Age, gender, urine density, serum urea, creatinine levels and urodynamic parameters were noted. Urinary type 1, type 3 collagen and its precursor procollagen type 3 and serum type 1 and 3 collagen were determined by ELISA. Results 72 patients were included (LC group, n:31, NC group, n:24, C group n:17, mean age 7,39 +/- 1,24 years). No significant difference was observed in the comparison of age, gender, urine density and serum urea and creatinine values. No significant difference was observed between the LC and NC groups for urodynamic parameters, except for bladder compliance. Urinary collagen type 1 in LC group (11,71 +/- 3,02 ng/ml) was found to be significantly higher than that of the C group (9,45 +/- 1,97 ng/ml) (p = 0,03). Urinary procollagen type 3 was significantly higher in LC group (103,15 +/- 24 ng/ml) when compared to C group (82,42 +/- 22,26 ng/ml) (p = 0.016). Urinary collagen type 1 level above 9.20 ng/ml was 80,6 % sensitive and 70,6 % specific and urinary procollagen type 3 level above 78 ng/ml was 87 % sensitive and 70,6 % specific in predicting low compliance. Discussion This study seems to be the first study in the literature to evaluate bladder fibrosis and compliance, biochemically, by measuring urinary collagen levels in NBD. Urinary fibrosis markers are not currently an alternative to urodynamics for bladder compliance, but they may have potential to reduce the need for urodynamics with this indication. Conclusion Determination of urinary collagen levels may be a marker of bladder wall fibrosis and may indirectly show decreased bladder compliance. It is plausible to say that invasive methods such as urodynamics may be less preferred for defining bladder compliance, instead, urinary biomarkers may have merit for this purpose in the future.Öğe The Results of Untethering Procedures with Intraoperative Neuromonitoring: Occult Spinal Dysraphism and Tethered Spinal Cord Secondary to Myelomeningocele(Halil Erdem Özel, 2018) Canaz, Hüseyin; Erdoğan, Ezgi Tuna; Alataş, İbrahimINTRODUCTION: Using intraoperative neuromonitoringin both primary and secondary tethered cord operations isaccepted as a necessity for a safer operation and guidingsurgeon in complex surgeries.METHODS: Twenty four operations which were monitoredwith three modalities; transcranial motor evoked potentials(TcMEP), free-run electromyography and direct nervestimulations. In group 1, there were 14 patients underwenttethered cord operations due to occult spinal dysraphism, ingroup 2 there were 10 patients underwent tethered cordoperations secondary to previous myelomeningocele repair.RESULTS: TcMEP responses of lower extremity were elicitedin 92 % in group 1, 80 % in group 2. TcMEP responses of analsphincter were elicited in 83 % in group 1, 60 % in group 2. NoTcMEP change was observed during the surgeries in bothgroup. Postoperative urodynamic results of both group wereimproved in 1 year period (78 % in group 1, 43 % in group 2).In patients with hypoactive bladder, we could not take analsphincter responses in TcMEP.DISCUSSION and CONCLUSION: Untethering of spinal cordboth in asymptomatic occult spinal dysraphism and TCSsecondary to MMC, can improve impaired urodynamic results.Intraoperative neuromonitoring and direct stimulation providesinformation for a safer surgery and guide surgical maneuversespecially in secondary untethering. Intraoperativeneurophysiological monitoring is beneficial for operations ofMMC patients with neurological deficits, to preserve theirresidual motor functions. Since anal sphincter functions arecorrelated with bladder functions, it is possible to get no analsphincter TcMEP response if patient has hypoactive bladder.
