Surgical treatment outcomes in subdural effusion: a clinical study.

OBJECTIVE: In this study, patients who underwent surgery due to subdural effusion were retrospectively analyzed. The location, depth and etiology of the subdural effusion, the surgical approach that was used and the recurrence rates were studied in these patients. METHOD: A total of 32 patients who were followed up and treated for subdural effusion at the Neurosurgery Clinic of the Yüzüncü Yil University School of Medicine were included in the study; 18 (56%) of the patients were male and 14 (44%) were female. The surgical techniques applied were surgical burr hole drainage, repeated subdural transaxial puncture and subduroperitoneal shunt approaches. The patients were evaluated by computerized tomography of the brain in week 1 and in the third month after surgery. Recurrences were evaluated based on radiological findings and the clinical condition of the patients. RESULT: The consciousness level of the patients was proportional to the mass effect of the subdural effusion. Lower recurrence rates were found in patients with a large midline shift resulting from the subdural effusion. In addition, recurrence rates were higher in patients with cerebral atrophy and lower protein content in the subdural effusion fluid. It was observed that these patients responded better to the subduroperitoneal shunt treatment.

A case of metastatic spinal Ewing's sarcoma misdiagnosed as brucellosis and transverse myelitis.

An 11-year-old girl was admitted with back pain for 2 months, inability to walk for 15 days, and enuresis and encopresis for 2 days. She had been hospitalized with the diagnosis of brucellosis in another hospital. At presentation, she had paraplegia, sphincter dysfunction, and bilateral sensory loss below the T6 level, and was initially diagnosed with transverse myelitis caused by brucellosis. On the third day of hospitalization, however, agglutination test for brucella was negative, but it was positive for Salmonella. Therefore, transverse myelitis was considered to be due to salmonellosis. Thoracic spine magnetic resonance imaging showed an extradural, paraspinal mass at the level of T6-T7. The mass was totally extracted, and histopathological examination revealed Ewing's sarcoma. During follow-up, no improvement in paraplegia was noted and an enlarged presacral decubital ulcer developed. Aside from supportive care, local radiotherapy was applied. Unfortunately, the patient died from probable infection 9 months after the diagnosis. We emphasize that metastatic spinal Ewing's sarcoma may mimic brucellosis and transverse myelitis in childhood.

Comparing open surgery with endoscopic releasing in the treatment of carpal tunnel syndrome.

AIM: The aim of this study is to retrospectively assess the complications and result of cases that underwent open surgery or endoscopic releasing for carpel tunnel syndrome. METHOD: A total of 50 cases of carpel tunnel syndrome, 30 of whom underwent endoscopic release using the biportal extrabursal technique described by Chow, and the other 20 that underwent open surgery were included in the study. Average age of the cases was 41 (24 - 62), 44 of them were females and 6 males. RESULTS: Follow-up examinations of the patients at the first and third month after operation revealed no limitation of activity in 40 (80 %) cases, minimal limitation in 4 (8 %), moderate limitation in 5 (10 %) and significant limitation in 1 (2 %). Among the group that underwent endoscopic release, as a major complication, the median nerve was almost totally cut in a patient undergoing endoscopic release. During the same operation setting perifascicular neurorrhaphy was done. Fourth and fifth digital nerve lesions occurred in three cases. Among the group that underwent open surgery fourth and fifth digital nerve injury occurred in one case, and in another case severe inflammation requiring reoperation occurred. CONCLUSION: Before intervention, cases of carpal tunnel syndrome should be examined well as regards which technique to use. Experience of the surgeon with the technique to be used should also be taken into consideration. Endoscopic carpal tunnel releasing, though a relatively easier procedure, leads to neurovascular injuries more frequently than open surgery; thus open surgery appears to be safer.

Brucellar spondylodiscitis: MRI diagnosis.

Early diagnosis of brucellar spondylodiscitis is often difficult because of the long latent period. Radiographs of the spine, bone scan, and computed tomography (CT) scan provide insufficient data. Among 25 patients with brucellar spondylodiscitis studied by magnetic resonance imaging (MRI), 9 were in the acute stage and 16 were in the chronic stage. MRI is the investigation method of choice in diagnosing brucellar spondylodiscitis.

[Cranial gunshot injuries and treatment approaches]. / Kranyal atesli silah yaralanmalari ve tedavi yaklasimlari.

21 patients with gunshot wounds were retrospectively evaluated. They were 19 male and 2 female, age range was 9-24. All of the patients underwent a plain x-ray and computed tomography evaluation. 9 patients had intracerebral hematoma, 4 had subdural hematoma, 1 had epidural hematoma and 1 had intraventricular hematoma. 9 patients were observed to have bullet in the cranium. All the patients with glasgow coma scale 3-5 at the admittance died. 15 patients underwent surgical treatment. 3 patients had cerebrospinal fluid fistula postoperatively and underwent reoperation. Extensivity of the lacerated brain, localization of the lesion and the glasgow coma scale at the admittance affect the outcome in gunshot wounds.