Evaluation of factors affecting prognosis and mortality in geriatric patients presented to the emergency service with head trauma.

Objective: Head trauma, a cause of serious morbidity and mortality in general, is among the most common causes of emergency department visits in geriatric patients. In this context, this study investigated the factors affecting prognosis and mortality in geriatric patients presenting with head trauma at the emergency department. Methods: This retrospective cohort study included 842 patients aged 65 years and above who presented with head trauma to the emergency department between January 1, 2019, and December 31, 2019. Demographic and clinical data of the 622 patients included in the study were analyzed. Results: A total of 622 geriatric patients with head trauma were included in this study. Of these, 54.2% (337/622) were men, and 45.8% (285/622) were women. The mean age of the patients was 75.3 ± 7.5 years. Antihypertensives were the most common medications taken by the patients. Subdural hematoma is the most frequently observed cranial pathology. A simple fall is the most observed mechanism for trauma. A total of 17.5% (109/622) of the patients were admitted to the hospital. Of these patients, 8.4% (52/622) were transferred to the intensive care unit and 2.6% (16/622) of the patients died. Conclusion: Mortality would be expected to be higher in elderly patients with head trauma, hypotension, or high lactate levels. The need for intensive care unit transfer was higher in patients with coronary artery disease. The mortality rate of the patients increased with an increasing length of hospital stay.

The effect of subthalamic nucleus - Deep brain stimulation and different stimulation frequencies on cerebral hemodynamics in Parkinson's disease: A transcranial doppler study.

OBJECTIVES: To investigate the effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) and to compare low-frequency versus high-frequency STN-DBS on hemodynamic parameters of the middle cerebral artery between patients with advanced Parkinson's disease and age-sex matched healthy controls. PATIENTS AND METHODS: Eighteen patients with advanced Parkinson's disease (PD) with bilateral STN-DBS and 18 control subjects underwent Transcranial Doppler Ultrasound (TCDU) were included in the study. The hemodynamic parameters including blood flow velocity (FV), pulsatility index (PI) and, resistance index (RI) of the right middle cerebral artery (MCA) were measured and compared during the phases using TCDU. The first DBS-off, the second low-frequency DBS of 60 Hz, and the third high-frequency DBS of 130 Hz were compared. RESULTS: PD patients had significantly higher MCA-PI values compared with controls (0.99 ± 0.27 vs. 0.82 ± 0.14) (p = 0.031). Also, the MCA-PI values were higher in the low-frequency DBS (0.94 ± 0.14) and high-frequency DBS (0.93 ± 0.16) than in the controls (0.82 ± 0.14) (p = 0.022 and p = 0.041, respectively). There were no significant differences of FV and RI values among the DBS-on, DBS-off and, controls. The RI values were higher in the PD patients than in the controls, although these were not statistically significant. Also, PI values of the MCA decrease in different frequencies (60 Hz or 130 Hz). CONCLUSION: The results of this study showed that MCA-PI values are higher in advanced PD compared with controls. These indices indicate that MCA resistances and impedances are increased in advanced PD. Low- or high-frequency DBS treatment have beneficial effect to reduce high PI in advanced PD patients.

Management of intracranial hemorrhage in hemophilia A patients.

INTRODUCTION: Intracranial hemorrhage due to head trauma in patients with hemophilia is a major cause of mortality and morbidity. The incidence of central nervous system bleeding in these patients is between 3 and 8%. In this study, we shared our experience on the treatment and follow-up of seven pediatric patients with hemophilia A who had intracranial bleeding due to trauma. MATERIALS AND METHODS: Between 2010 and 2019, the clinical and radiological findings of seven pediatric patients with hemophilia A with intracranial hemorrhage were retrospectively evaluated in our clinic. One patient underwent operation owing to intracranial hemorrhage, and the other six underwent conservative treatment. Hemoglobin, aPTT (activated partial thromboplastin time), and factor VIII levels were measured at regular intervals. For intracranial hemorrhage follow-up, regular computed tomography (CT) was performed. RESULTS: All patients visited the emergency department with initial neurological complaints. Further, two of the seven patients died, one was treated with sequelae (cerebral palsy), and the other four were treated without sequelae. CONCLUSIONS: Early diagnosis and treatment of intracranial hemorrhage is very important in patients with bleeding disorders. Factor VIII replacement should be performed in such patients prior to radiological examinations and consultations. The main objective should be to bring factor VIII levels to normal limits during their treatment and follow-up.

Comparison of Dural Splitting and Duraplasty in Patients with Chiari Type I Malformation: Relationship between Tonsillo-Dural Distance and Syrinx Cavity.

AIM: To compare the clinical and radiological results of dural splitting and duraplasty in patients with Chiari Type I Malformation. MATERIAL AND METHODS: This study includes 113 adult patients with Chiari Type I malformation treated between 2009 and 2013. The patients were divided into two groups according to the surgical method (Group 1: dural splitting, Group 2: duraplasty). Neurological examinations and magnetic resonance imaging (MRI) scans were recorded periodically on 3rd, 6th,and 12th months at the postoperative period. The tonsillo-dural distance (TDD) and regression rate of the syrinx cavity were measured on T1 and T2 weighted sagittal MRI scans at the postoperative period. RESULTS: The ratio of syrinx regression was %49.6 in the Group 1 and %54.6 in the Group 2. This result was statistically significant. The TDD increased in Group 2 and this result was statistically significant (p < 0.05). Postoperative pain and numbness decreased in both groups and no statistically significant difference was detected. CONCLUSION: There was no relationship between tonsillar herniation length and the width of syringomyelic cavity. The syrinx cavity more regressed in the group 2 than group 1. There was no relation between the TDD and the ratio of syrinx regression.

Cervical Hemilaminoplasty with Miniplates in Long Segment Intradural Extramedullary Ependymoma: Case Report and Technical Note.

The surgical approaches for spinal tumors, to a great extent, have been developed in accordance with the developments in medical technology. Today, many surgical techniques are implemented as anterior, anterolateral, posterior, posterolateral and combined approaches. Due to its low morbidity, the posterior approach is the more preferred one. Laminectomy is a widely used technique, especially in neoplastic lesions. However, following laminectomy, there are numerous complications such as instability, kyphotic deformity and scar formation. In this paper, the excision of a tumor that was located intradural-extramedullary at the C3-C7 level with the cervical hemilaminoplasty technique is described. A 47-year-old female patient presented to our clinic with increasing complaints of neck and left arm pain, left arm numbness and searing pain for the last 10 years. On examination, hypoesthesia at the C4-7 dermatomes in the left upper extremity, an increase in deep tendon reflexes, and bilateral positive Hoffmann reflexes were observed. C3-C7 laminae were opened unilaterally on the right side with a midline skin incision. The laminae were drilled with a high-speed drill to provide a wide opening, both on the midline obliquely and from the border of the lamina-facet joint. After the tumor was totally excised, hemilaminae were placed into the previous position and reconstructed with mini-plates and screws. Cervical hemilaminoplasty provides a wide field of vision in tumor surgery of this region. Besides, the reconstruction of hemilaminae is important for stability. As the integrity of the spinal canal is preserved during reoperations of this region, the risk of complications is decreased.

The Management of Blood Loss in Non-Syndromic Craniosynostosis Patients Undergoing Barrel Stave Osteotomy.

AIM: Barrel stave osteotomy is a widely used procedure in neurosurgery for the majority of craniosynostosis patients. Both in the intraoperative and postoperative periods, there is inevitable leakage type bleeding from the bones undergoing osteotomy. A number of studies have been performed in order to prevent this complication but a concise procedure is still lacking. MATERIAL AND METHODS: Synostectomy and parietotemporal barrel stave osteotomy were applied to 143 patients who were operated on with a diagnosis of craniosynostosis between the years 2005-2013. At the beginning to osteotomy, 5 ml/kg erythrocyte suspension (ES) was given for probable blood loss. Whole blood count was performed at the postoperative 1st and 6th hours and cases with hemoglobin levels below 10 or with hematocrit levels which had decreased more than 5% between the 1st and 6th hours were administered erythrocyte transfusion. RESULTS: Of the patients, 100 were boys and 43 were girls. Of these, 98 had metopic, 30 had sagittal, 9 had metopic+sagittal, 4 had unilateral, 2 had bilateral and 6 had coronal synostosis. All the cases were administered intraoperative erythrocyte suspension. The preoperative amount of administered mean erythrocyte was 8.61 ml/kg. In the postoperative period, 92 patients were administered erythrocyte suspension. The postoperative amount of administered mean erythrocyte suspension was 7.98 ml/kg. CONCLUSION: For an operated infant with craniosynostosis who is operated on in the first year of life, undergoing osteotomy and inevitable bone-borne blood losses are very important and these have to be replaced immediately.

Evaluation of Aggressive Behavior and Invasive Features of Pituitary Adenomas Using Radiological, Surgical, Clinical and Histopathological Markers.

AIM: Total surgical resection of pituitary macroadenomas is difficult due to the location of the adenoma and the propensity to invade surrounding tissues. The purpose of this study was to evaluate the risk factors for invasive and aggressive pituitary macroadenomas using radiological, hormonal, clinical, and immunohistochemical markers. MATERIAL AND METHODS: Seventy cases of pituitary macroadenoma were examined. Age, gender, symptoms, the presence of fibrosis within the adenoma, hormonal levels, radiological findings, pathological results and immunohistochemical staining of the patients were evaluated using statistical methods. RESULTS: We observed that the patients with macroadenomas in our study most frequently presented during their 5th decade. The most frequent pituitary adenomas were non-functional, GH-secreting and PRL-secreting macroadenomas. The most frequent complaint was vision loss, headache and acral growth. Based on Magnetic Resonance Imaging (MRI) results, it was observed that the degree of invasion into surrounding tissues increased as the size of the macroadenoma increased. Macroadenomas that had invaded into the cavernous sinus invasion or that had a fibrotic tumor structure had a low probability of being resectable. There were no significant relationships between invasive behavior and p53, telomerase, ghrelin and CD46. CONCLUSION: It is not possible to identify only one factor that affects the prognosis of patients with pituitary macroadenomas. The contribution of the experience of surgeon to the treatment is surely beyond dispute. Fibrotic tumor structure, the surgical technique, the type of hormone, and cavernous sinus invasion affect the ability to perform a total resection and the overall prognosis.

The Results of the Surgical Treatment of Spontaneous Rhinorrhea via Craniotomy and the Contribution of CT Cisternography to the Detection of Exact Leakage Side of CSF.

AIM: To share the results of conventional surgery in rhinorrhea and the contribution of computerized tomography (CT) cisternography to determination of the site of cerebrospinal fluid (CSF) leak. MATERIAL AND METHODS: Twelve cases treated for spontaneous rhinorrhea were included in this study. All the cases underwent cranial CT and magnetic resonance imaging (MRI). CT cisternography was performed in four patients whose bone defect or leakage site could not be detected by CT and MRI. In order to repair the defect, either the galea or galea together with collagen matrix was used and the procedure was supported with fibrin glue. RESULTS: In the cases, postoperative rhinorrhea was seen in neither the early nor the late follow up period. We observed no complications related to CT cisternography or craniotomy. The leakage area was successfully detected with CT cisternography when the other methods failed. CONCLUSION: Bone defect can usually be shown by means of CT. However, when bone-defect cannot be shown or the dura in the defective area is intact, CT cisternography is useful to show the CSF leak. Conventional surgery was very succesful in the treatment of spontaneous rhinorrhea but it was cosmetically problematic. In the patients both treated with galea and galea together with collagen matrix, the repair of the defect was successful.

Comparison of subgaleal and subdural closed drainage system in the surgical treatment of chronic subdural hematoma.

OBJECTIVE: One or two burr-hole craniostomies with subgaleal or subdural drainage system and irrigation are the most common methods for surgical treatment of CSDH. The aim of this study is to compare the advantages or disadvantages of these techniques used for CSDH. METHODS: Seventy patients were treated by burr-hole subdural drainage or subgaleal drainage system with irrigation. Our patients were classified into two groups according to the operative procedure as follows: Group I, one or two burr-hole craniostomy with subgaleal closed system drainage and irrigation (n=36), Group II, one or two burr-hole craniostomies with subdural closed drainage system and irrigation (n=38). We compared male and female ratios, complication rates, and age distribution between groups. RESULTS: There was no remarkable difference between recurrence rates of the two groups. Recurrence rate was 6.25% in Group I and 7.8% in Group II. Subdural empyema occurred in one of the patients in Group II. Symptomatic pneumocephalus did not develop in patients. Four patients were reoperated for recurrence at an average of 12-20 days after the operation with the same methods. CONCLUSION: Both of the techniques have a higher cure rate and a lower risk of recurrence. However, subgaleal drainage system is relatively less invasive, safe, and technically easy. So it is applicable for aged and higher risk patients.