A Comparison of Subgaleal Active Drainage and Subdural Passive Drainage and an Analysis of Factors Affecting Chronic Subdural Hematoma Outcomes.

AIM: To analyze and to compare the factors that influence the recurrence of chronic subdural hematoma (CSDH) among patients treated with subdural non-suction-assisted passive drainage, subgaleal suction-assisted active drainage, and without drainage. MATERIAL AND METHODS: We retrospectively evaluated 87 surgical patients with a diagnosis of CSDH treated between 2007 and 2018 using patient records from the neurosurgery archive of our faculty. The patients were divided into three groups: drainfree group (group A), subdural passive drainage group (group B), and subgaleal active drainage group (group C). Recurrence was defined as an increase in hematoma volume on imaging and persistence of the patient?s symptoms. RESULTS: Patients with double-membrane CSDH exhibited higher recurrence rates (p=0.043) and those with low-density CSDH exhibited lower recurrence rates (p=0.015) compared to the other patients. No relationship was found between the number of burr holes made and CSDH recurrence (p=0.177). Group C showed the lowest recurrence rate (13.3%), but the differences between groups were not statistically significant. CONCLUSION: Hematoma density, membrane type, postoperative Glasgow Outcome Scale scores, and postoperative drainage time were found to be statistically significant predictors of recurrence. Burr-hole craniotomy with subgaleal active drainage is a safe and effective method for preventing CSDH recurrence and carries a reduced risk of parenchymal injury.

The effects of protein kinase C activator phorbol dibutyrate on traumatic brain edema and aquaporin-4 expression.

BACKGROUND: Aquaporin-4 (AQP4) is the major water channel in the central nervous system. Brain edema emerges from increased AQP4 expression in traumatic brain injury (TBI). Cell line studies have shown that the protein kinase activator phorbol ester exerts a suppressive effect on AQP4 and water permeability. The aim of this study was to investigate the effects of a phorbol ester, phorbol dibutyrate (PDBu), on increased TBI AQP4 expression and accompanying brain edema. METHODS: Fifty-six male Wistar rats were first divided into two groups: the edema group, in which the percentage of water in brain tissue would be evaluated, and the immunohistochemical group, allowing AQP4 expression to be determined. Both groups were further sub-divided into four groups consisting of 7 subjects. These four groups were as follows: sham-operated control group, severe diffuse TBI group, 0.9% saline-treated diffuse TBI group, and the PDBu-treated diffuse TBI group (2300 µg/kg, iv). The results were evaluated statistically. RESULTS: PDBu treatment significantly reduced brain water concentration (p<0.001). Furthermore, PDBu was found to reduce trauma-induced AQP4 upregulation (p<0.05). CONCLUSION: This study showed that traumatic brain edema was prevented by intravenous PDBu administration via AQP4 downregulation, supporting the idea emphasizing the importance of AQP4 expression control in TBI.

Analyses of clinical prognostic factors in operated traumatic acute subdural hematomas.

BACKGROUND: Traumatic acute subdural hematoma is the most lethal of all head injuries. METHODS: In this study, 113 patients with the diagnosis of posttraumatic acute subdural hematoma, who were operated between 1998 and 2006, were reviewed retrospectively. Statistical analysis was performed to detect any effects of the variables of age, Glasgow Coma Scale (GCS) score on admission, time interval between the trauma and operation, and abnormality in the pupil reaction on the disease mortality and morbidity. RESULTS: Results obtained in the study are discussed and compared with the related current literature. The overall mortality in 113 patients was 56.6%. CONCLUSION: According to the results, the most important determinants of the prognosis are GCS score of the patient on admission, abnormality in pupil reaction, timing of the operation, and the patient's age.

[Epidemiological study in head injury patients]. / Kafa travmali hastalarda epidemiyolojik çalisma.

BACKGROUND: The aim of this study was to determine the hospital-based epidemiological data of the head injury patients who admitted to our Emergency Surgery Department. METHODS: The records of the patients (284 males [66%], 146 females [34%]; mean age 30+/-19) with head injury who admitted to our Emergency Surgery Department between 01.01.2006 - 31.12.2006 were analyzed retrospectively. RESULTS: Among the age groups, most head injuries occurred in children (22%) and young adults (30%). The most common trauma types were due to falls (40%) and motor vehicle accidents (37%). The mortality rate in head injury patients was 11%, serious morbidity was 2%, and the rate of deaths from head injury among all deaths in 2006 was 30%. CONCLUSION: According to these data, the most common causes of death in head-injured patients are falls (0-16 years of age) and outside vehicle traffic accidents and cranial gunshot wounds (16-35 years of age), especially for males. Admission Glasgow Coma Score is an important prognostic factor in head-injured patients. Primary precautions for head injury must be taken according to each age group. Further development of the diagnosis and treatment options will help to lower the mortality and morbidity of patients with traumatic brain injury.

[Penetrating transorbital intracranial foreign body]. / Penetran transorbital uzanimli intrakraniyal yabanci cisim.

We report a seven year-old boy who suffered left orbital penetration of an industrial sewing machine needle. The needle passing through the left orbit and sphenoid bone at the posterior was extending into the layers of the dura of the left temporal lobe. In this patient, we preferred surgical approach and there was no complication after surgery. Penetrating intraorbital foreign materials with intracranial extension may lead to complications such as intracerebral hematoma, brain abscess, CSF fistula, proptosis of the eye, diplopia, orbital cellulitis and periorbital abscess. They have to be removed by surgical approach to prevent potential complications.