Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarct.

AIM: Decompressive hemicraniectomy for a malignant middle cerebral artery infarct can be a life-saving surgical treatment. We aimed to investigate the surgical treatment results in cases that underwent decompressive hemicraniectomy for a malignant middle cerebral artery infarct in this study. MATERIAL AND METHODS: The clinical condition, radiological findings and surgical treatment results of 42 cases that underwent decompressive hemicraniectomy for a malignant middle cerebral artery infarct were retrospectively evaluated in this study. RESULTS: There were 19 males and 23 females. The age range was 27 to 78 years with a mean age of 57.6 years. The infarct area was the non-dominant hemisphere in 20 cases and the dominant hemisphere in 22 cases. Preoperative Glasgow coma scale (GCS) scores were 5 to 12. The 42 cases with a malignant middle cerebral artery infarct were divided into 2 groups according to the Glasgow outcome scale (GOS) as the unfavorable outcome group (Group 1) with a score of 1 to 3 and the favorable outcome group with a score of 4 to 5 (Group 2). There were 27 cases in Group 1 and 15 in Group 2. There was a statistically significant association between a good result and age, Glasgow coma scale at the time of surgery, duration until surgery, and non-dominant hemisphere involvement. All cases with a Glasgow coma scale score of 7 or below had a poor outcome. CONCLUSION: Decompressive hemicraniectomy in malignant middle cerebral artery infarct can be a life-saving procedure but is not useful in cases with a Glasgow coma scale score of 7 and below.

Giant cell reparative granuloma of the axis.

Giant cell reparative granuloma (GCRG) is a rare, benign fibroosseous lesion. It typically arises in the mandible and maxilla, and less frequently in the skull bones. We report a case of GCRG of the axis, which is the first to be reported in the literature. A 35-year-old man was admitted to our clinic with the complaint of pain at his neck. There was no neurological deficit. CT and MRI showed a lesion destructing the body of the axis. Biopsy specimens were taken through the transoral-transpharyngeal route. Histopathological diagnosis was GCRG. The lesion was removed subtotally by the same route. We filled the tumor cavity with a bone graft and the patient was discharged with a halo brace without any neurological deficits. The follow-up CT revealed one year after the surgery showed sclerosis at the tumor site. The etiopathogenesis of GCRG is still controversial and the differential diagnosis, especially from giant cell tumor of bone is quite difficult. The treatment of choice for these lesions is complete surgical removal. Some authors recommend radiotherapy if total removal fails.

Cerebral salt wasting in a child with cervicothoracic hematoma.

Although the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is commonly observed in patients with acute or chronic central nervous system (CNS) disorders, cerebral salt wasting (CSW) that results in hyponatremia has rarely been reported in children. Both SIADH and CSW result in increased urinary sodium excretion and hyponatremia. However, the management protocols for these two conditions are quite different; volume restriction is used in treating SIADH, while volume expansion is necessary for the treatment of CSW. We present a case of CSW in a child with cervicothoracic hematoma secondary to head and cervicothoracic trauma, without evidence of brain edema. The child was diagnosed on the basis of high urinary sodium excretion resulting in hyponatremia and low serum osmolarity. Improvements in serum sodium levels after saline hydration confirmed this diagnosis. We believe that potentially dangerous cases of hyponatremia should be carefully evaluated in children with cervicothoracic hematoma secondary to trauma, including situations in which brain edema is absent.

Intramedullary spinal epidermoid associated with an intramedullary lipoma.

True intramedullary epidermoids and true intramedullary lipomas of the spinal cord are very rare lesions. To our knowledge, there has been no reported case associated with an intramedullary spinal lipoma. This is the first reported case with the association of these two lesions. In this report a 3-year-old boy with intramedullary spinal lipoma is presented. We discuss the frequency, clinical features, MRI characteristics and limits of surgical treatment of these tumors and review the associated literature.