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Cerrah‹ Nöroanatom‹ E⁄‹T‹M‹ Supratentoryal S‹

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Cerrah‹ Nöroanatom‹ E⁄‹T‹M‹ Supratentoryal S‹ Türk Nöroşirürji Derneği Cerrahi Nöroanatomi Öğretim ve Eğitim Grubu Bülteni / Aralık 2008 / Sayı: 2 CERRAH‹ NÖROANATOM‹ E⁄‹T‹M‹ SUPRATENTORYAL S‹STERNALAR KAFA TABANINA ENDOSKOP‹K ENDONASAL YAKLAfiIMLAR CERRAH‹ NÖROANATOM‹ GRUBU KURSU “SUPRA-‹NFRATENTORYAL BÖLGE ve VENTR‹KÜLLER‹N M‹KROCERRAH‹ ANATOM‹S‹ ve YAKLAfiIMLAR” 2 Türk Nöroşirürji Derneği Cerrahi Nöroanatomi Bülteni Baflkan›n Mesaj› TÜRK NÖROfi‹RÜRJ‹ DERNE⁄‹ YÖNET‹M KURULU De¤erli Meslektafllar›m, Baflkan Grubumuzun genel kurulu Türk Nöroflirurji Derne¤i 22. Bilimsel Kongresi Dr. ETHEM BEfiKONAKLI s›ras›nda yap›ld› ve yeni yönetim kurulunda Dr.Necmettin Tanr›över, Dr. 2. Baflkan Erdener Timurkaynak, Dr. Naci Balak, Dr. Funda Batay ve Dr. Hasan Ça¤lar Dr. MURAD BAVBEK U¤ur asil üye, Dr. Çetin Evliyao¤lu ve Dr. Emel Avc› yedek üye olarak yer Sekreter ald›lar. Yönetim kurulu olarak bir y›l aradan sonra Cerrahi Nöroanatomi Dr. A⁄AHAN ÜNLÜ Ö¤retim ve E¤itim Grubunun ikinci bültenini yay›nl›yoruz. Bültende, Muhasip grubumuzun kurucu baflkan› Prof. Dr. Erdener Timurkaynak’›n Cerrahi Dr. MEHMET YAfiAR KAYNAR Nöroanatominin k›sa tarihi ve Noroflirurji e¤itimindeki yerini tart›flan Veznedar makalesi ile birlikte iki adet derleme yer almaktad›r. ‹lk derleme noroflirurji Dr. SÜLEYMAN ÇAYLI prati¤inde cerrahi s›ras›nda s›kl›kla kulland›¤›m›z subaraknoidal sisternalar›n mikrocerrahi anatomisini tart›flmaktad›r. Prof. Dr. M. Gazi Yaflargil taraf›ndan 1970’li y›llarda supratentoryal patolojiler için tan›mlanan intra- ve intersisternal mikrocerrahi yaklafl›m prensiplerinin iyi anlafl›labilmesi için bu makalede yer alan 10 farkl› sisternan›n s›n›rlar›n›n, içindeki nörovasküler yap›lar›n ve iliflkili membranlar›n iyi bilinmesi TÜRK NÖROfi‹RÜRJ‹ DERNE⁄‹ gerekti¤i kan›s›nday›m. ‹kinci derleme, kafa taban›na yönelik cerrahilerde CERRAH‹ NÖROANATOM‹ giderek ön plana ç›kan endoskopik endonasal yaklafl›mlar› gözden Ö⁄RET‹M ve E⁄‹T‹M GRUBU geçirmektedir. Her iki derlemede yer verilen 50’nin üzerindeki diseksiyon foto¤raflar›ndaki amaç okuyucuya üc boyutlu anatomiyi mümkün oldu¤unca Baflkan detayl› verebilmektir. Dr. NECMETT‹N TANRIÖVER Üyeler Cerrahi Noroanatomi Grubu olarak bu y›l ilk kez Turk Nöroflirurji Derne¤i Dr. ERDENER T‹MURKAYNAK 23. Bilimsel Kongresi hemen öncesinde (17 Nisan 2009), kongre merkezinde Dr. NAC‹ BALAK kapsaml› bir kurs düzenleyecegiz. “Supra- ‹nfratentoryal Bölge ve Dr. FUNDA BATAY Ventrikül Mikrocerrahi Anatomisi ve Yaklafl›mlar›” konulu kursumuzda Dr. HASAN ÇA⁄LAR U⁄UR amac›m›z konular›nda deneyimli uzmanlar›n tecrübelerini genç klinisyenler ile paylasmalar›n› sa¤lamak ve her yaklafl›m için temeli oluflturan cerrahi anatomiyi detayl› olarak gözden geçirmektir. Bu kursun genifl program› ileriki gunlerde Türk Nöroflirurji Derne¤i web sayfas›nda duyurulacakt›r. Taflkent Caddesi 13/4 Bahçelievler 06500 ANKARA Özellikle genç meslektafllar›m›z› Cerrahi Nöroanatomi Ö¤retim ve E¤itim Tel : + 90 312 212 64 08 Grubu içinde aktif çal›flmaya ve grubumuza bülten içindeki baflvuru formu Faks: + 90 312 215 46 26 ile birlikte üye olmaya davet ediyoruz. Elinizdeki bültenin haz›rlanmas›nda Web: www.turknorosirurji.org.tr E-posta: [email protected] eme¤i geçen tüm meslektafllar›ma teflekkür ederim. Yeni dönemin derne¤imiz ve grubumuz için baflar›l› geçmesini dilerim. BULUfi Tasar›m ve Matbaac›l›k Hizmetleri Sayg›lar›mla, Tel: (312) 222 44 06 E-posta: [email protected] Dr. Necmettin Tanr›över T.N.D. Cerrahi Nöroanatomi Grubu Baflkan› 2 Türk Nöroşirürji Derneği Cerrahi Nöroanatomi Bülteni 3 CERRAH‹ NÖROANATOM‹N‹N DÜNÜ, BUGÜNÜ ve NÖROfi‹RÜRJ‹ E⁄‹T‹M‹NDEK‹ YER‹ It represents a lifelong attempt to join an understanding of the anatomy and intricacies of the brain that would improve the safety, gentleness, and accuracy of surgery for my patients. Albert L.Rhoton Jr. Anatomy to the neurosurgeon is like the sun for our planet. Robert Spetzler Beyin, nörovasküler yap›lar›n karmafl›kl›¤›ndan sonra hayvanlarda anatomik diseksiyonlar yapm›flt›r. dolay› her zaman gizemini koruyan bir doku olmufltur. S›¤›r beyni içine s›cak yap›flkan maddeler enjekte Bu dokuda var olan sorunu çözmek amac›yla yap›lacak ederek ventrikül yap›lar›n› 3 boyutlu ortaya koymufl ve olan cerrahi giriflim de bir o kadar karmafl›k ve özel çizimler yapm›flt›r. Omurga ve pelvisin gerçek fleklini ve e¤itim ile deneyim isteyen bir süreçtir. Bu sürecin boyutlar›n› ilk çizen kiflidir. Da Vinci’nin anatomiye de¤iflmez arac› ise cerrahi yaflant›m›z› çok kolaylaflt›ran esas katk›s› kalvarium ve dolafl›m sisteminin 3 boyutlu mikrocerrahi e¤itimidir. Mikrocerrahi anatomik bilgiler, (kesitlerinin) görüntülerini çizmifl olmas›d›r. Ancak cerrahi için yap›lan dokuya en az zarar veren ama bir o anatomiye bu kadar katk› sa¤layan dahi Da Vinci 28 y›l kadar da radikal cerrahiye izin verecek koridorlar›n anatomik çal›flmalar ve resimler yapt›ktan sonra bulunmas›n› sa¤lar. ölümünden 4 y›l önce Papa taraf›ndan anatomik resim Anatomi tarihine k›saca bakt›¤›m›zda Edwin Smith yapmas› yasaklanm›flt›r. papirüsünün MÖ 1600 y›llar›nda yaz›lm›fl olan ve Andreas Vesalius (1514–1564) modern anlamda ilk bilinen en eski t›bbi metin oldu¤unu görüyoruz. Metnin insan anatomi kitab›n›n (De Humanis Corporis Fabrica- ‹mhotep (firavun’un baflhekimi) taraf›ndan yaz›ld›¤› On the Workings of the Human Body) yazar› olan bir san›lmaktad›r. Travma cerrahisi, anatomik gözlemler, hekim ve anatomisttir. Gabriel Fallopius (1523–1562) tan› ve tedaviler ile ilgili bilgiler içerir. Bu papirüste kafa anatomisi ile ilgilenmifltir. Timpanium, iç ve orta kranial sütürler, meninksler, beynin d›fl yüzeyi, BOS ve kulak, vestibül ve kohleay› tan›mlam›flt›r. Fasial sinirin intrakranial pulsasyonlar ilk kez tan›mlanm›flt›r. vestibulokohlear sinirden ayr›ld›ktan sonra girdi¤i Hippocrates evrensel olarak t›bb›n babas› kabul Fallop kanal›n› ilk kez tan›mlam›flt›r. edilmektedir. Ayn› zamanda anatomi biliminin de Türkiye’de ise anatomi ö¤retimi 4 dönemde yarat›c›s› oldu¤u san›lmaktad›r. toplan›r: Medrese, fianizade, T›p hane ve Cerrah hane-i Bilinen ilk anatomist olan MÖ 335 ile 280 y›llar› Amire ve Mekteb-i T›bbiye-i fiahane dönemi. Medrese aras›nda yaflayan Herophilus ise Kad›köylüdür ve ilk dönemi 1200 ile 1816 y›llar› aras›n› kapsar. 1205’de insan diseksiyonlar›n› Erasistratus ile birlikte yapm›flt›r. Kayseri Darüflflifas›’n›n kuruluflu ile ivme kazanm›flt›r. Sinir sistemi üzerinde çal›flm›flt›r. Sinirlerin ‹bn-i Sina’n›n (980–1037) El-Kanun Fi’t-T›b adl› eseri damarlardan ayr› oldu¤unu ortaya koymufltur. Motor ve medrese dönemine ›fl›k tutan en önemli eser olmufltur. duyu sinirlerini ay›rm›flt›r. Erasistratus ise MÖ 330–250 Hekimbafl› Ömer Çelebi’nin Enmüzec Al-t›p adl› eseri ise y›llar› aras›nda yaflam›fl ve canl›da (insan ve hayvan) savaflta ölülere yap›lan diseksiyondan söz etmektedir. diseksiyonlar yapm›flt›r. Bu nedenle de etik tart›flmalar› 1816-1827 y›llar› aras›nda fianizade Mehmet Ataullah alevlendirmifltir. Sinirlerin beyinden ç›kt›¤›n› ve vücuda Efendi’nin Mir’at’ül Ebdan Fi Teflrih-i Aza’ül ‹nsan adl› ruhu da¤›tt›¤›n› ileri sürmüfltür. Bergamal› Galen’in anatomi kitab› ilk bas›l› t›p kitab›d›r. Bat›l› ortaya koydu¤u bilgiler ise bin y›l boyunca Avrupa kaynaklardan çeviri ve derlemedir. 3. dönem olan t›bb›n› yönlendirmifltir. Hayvanlarda canl› diseksiyonlar T›phane ve Cerrahhane-i Amire döneminde Sultan II. (yaparak spinal kord ve böbrek ifllevleri üzerinde Mahmut taraf›ndan okul aç›lm›fl ve t›bbiyede 5, cerrah çal›flm›flt›r. Aristotle’›n aksine ruhun ve benli¤in kalpte hanede 3 y›l e¤itim verilmifltir. Bu dönemde normal de¤il, beyinde oldu¤unu ileri sürmüfltür. Bergamal› anatomi e¤itimi verenler aras›nda Osman Saip Efendi Orabasius tükürük bezlerini, Efesli Rufus rekürren siniri vard›r. Bu dönemin sonuna kadar hala diseksiyon tan›mlam›flt›r. 1452 ile 1519 y›llar› aras›nda yaflayan Da e¤itimi planl› bir flekilde yap›lamam›flt›r. Mekteb-i Vinci ise hiç t›p e¤itimi almam›fl olmas›na ra¤men T›bbiye-i fiahane dönemi ise 1839 dan günümüze olan otopsi yapan doktorlar› izleyerek önce ölü insanlarda kadar zaman› kapsar. Bu dönemin bafllang›c›ndaki 4 Türk Nöroşirürji Derneği Cerrahi Nöroanatomi Bülteni önemli olaylar ise Sultan III. Selim taraf›ndan aç›lan Mikrocerrahi E¤itim ve Araflt›rma Merkezinin teknik ve okuldur. Bu döneme damgas›n› vuran bilim adamlar› ise e¤itim program› ac›s›ndan benzer laboratuar›n› Dr.C.A.Bernard ve Avusturyal› anatomist Dr. Spitzer’dir. kurmaya karar verdim.Bu Laboratuar›n kurulmas›nda Bu dönemin en önemli özelli¤i 1841 y›l›ndan sonra bana büyük destek veren Say›n Ö¤retmenim, anatomi e¤itiminde diseksiyonlara bafllanm›fl olmas›d›r. komutan›m Prof. Dr. Tümg. Necati Kölan’› en derin O günlerden bafllay›p bugüne kadar gelen süreçte ise sayg›lar›mla an›yorum 1985 y›l›nda, Gülhane Askeri T›p hala en önemli sorun kadavra bulunmas› zorlu¤udur. Akademisi Mikrocerrahi E¤itim ve Araflt›rma Merkezi Yak›n tarihimizde 1970’li y›llar Say›n Prof. Dr. e¤itime bafllam›flt›r. Örne¤i dünyada çok az olan teknik M.Gazi Yaflargil’in görkemli konumunun tüm dünyaca imkanlar› ve e¤itim program› ile(bu ifade Büyük Usta tan›nd›¤› y›llard›r. Büyük Usta Yaflargil tüm beyin Prof. M.G.Yasargil taraf›ndan, laboratuara konuk oldu¤u cerrahlar›na mikrocerrahi e¤itimini ve bu e¤itimde zaman söylenmifltir.) 2005 y›l›n ben Ufuk mikrocerrahi anatomik bilgilerin ne denli önemli Üniversitesine geçene kadar çal›flmalar›n› oldu¤unu göstermifltir. Mikrocerrahi uygulamalar›n sürdürmüfltür. Bu süre içinde de¤iflik cerrahi alanlardan beyin cerrahisi alan›na tafl›nmas›, tart›flmas›z Yaflargil gelen 1000 den fazla yurt içi ve d›fl›ndan cerraha ile birlikte flahlanan bir süreçtir.
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