Dr. Nernekli has a wide-ranging research background encompassing molecular imaging, surgical neuroanatomy, clinical outcome studies, and machine learning, focusing on medical image reconstruction and multimodal deep learning algorithms for classification and segmentation tasks. Currently, he is focused on investigating novel radiotracer and activatable Gd-based contrast agents to detect senescence in large animal models with PET/MRI. Furthermore, Dr. Nernekli is exploring the potential of ferumoxytol-MRI and two-photon microscopy to correlate theranostic nanoparticles in their natural environment in order to gain a deeper understanding of their interactions with tumor-associated microenvironments.
Medical Degree, Gazi University Faculty of Medicine (Ankara/Turkey) (2020)
Heike Daldrup-Link, Postdoctoral Faculty Sponsor
Cytodifferentiation of pituitary tumors influences pathogenesis and cavernous sinus invasion.
Journal of neurosurgery
Pituitary tumors (PTs) continue to present unique challenges given their proximity to the cavernous sinus, whereby invasive behavior can limit the extent of resection and surgical outcome, especially in functional tumors. The aim of this study was to elucidate patterns of cavernoinvasive behavior by PT subtype.A total of 169 consecutive first-time surgeries for PTs were analyzed; 45% of the tumors were functional. There were 64 pituitary transcription factor-1 (PIT-1)-expressing, 62 steroidogenic factor-1 (SF-1)-expressing, 38 T-box transcription factor (TPIT)-expressing, and 5 nonstaining PTs. The gold standard for cavernous sinus invasion (CSI) was based on histopathological examination of the cavernous sinus medial wall and intraoperative exploration.Cavernous sinus disease was present in 33% of patients. Of the Knosp grade 3 and 4 tumors, 12 (19%) expressed PIT-1, 7 (11%) expressed SF-1, 8 (21%) expressed TPIT, and 2 (40%), were nonstaining (p = 0.36). PIT-1 tumors had a significantly higher predilection for CSI: 53% versus 24% and 18% for TPIT and SF-1 tumors, respectively (OR 6.08, 95% CI 2.86-13.55; p < 0.001). Microscopic CSI-defined as Knosp grade 0-2 tumors with confirmed invasion-was present in 44% of PIT-1 tumors compared with 7% and 13% of TPIT and SF-1 tumors, respectively (OR 11.72, 95% CI 4.35-35.50; p < 0.001). Using the transcavernous approach to excise cavernous sinus disease, surgical biochemical remission rates for patients with acromegaly, prolactinoma, and Cushing disease were 88%, 87%, and 100%, respectively. The granule density of PIT-1 tumors and corticotroph functional status did not influence CSI.The likelihood of CSI differed by transcription factor expression; PIT-1-expressing tumors had a higher predilection for invading the cavernous sinus, particularly microscopically, compared with the other tumor subtypes. This elucidates a unique cavernoinvasive behavior absent in cells from other lineages. Innovative surgical techniques, however, can mitigate tumor behavior and achieve robust, reproducible biochemical remission and gross-total resection rates. These findings can have considerable implications on the surgical management and study of PT biology and behavior.
View details for DOI 10.3171/2023.3.JNS221949
View details for PubMedID 37119095
A simple technique for generating 3D endoscopic images.
Surgical neurology international
2023; 14: 54
Background: Most neurosurgical photographs are limited to two-dimensional (2D), in this sense, most teaching and learning of neuroanatomical structures occur without an appreciation of depth. The objective of this article is to describe a simple technique for obtaining right and left 2D endoscopic images with manual angulation of the optic.Methods: The implementation of a three-dimensional (3D) endoscopic image technique is reported. We first describe the background and core principles related to the methods employed. Photographs are taken demonstrating the principles and also during an endoscopic endonasal approach, illustrating the technique. Later, we divide our process into two sections containing explanations, illustrations, and descriptions.Results: The results of taking a photograph with an endoscope and its assembly to a 3D image has been divided into two parts: Photo acquisition and image processing.Conclusion: We conclude that the proposed method is successful in producing 3D endoscopic images.
View details for DOI 10.25259/SNI_1106_2022
View details for PubMedID 36895218