F. Çelik

Split Cord Malformation Type I And Lipomyelomeningocele: A Case Report

Spina bifida is a term comonly used to refer to myelomeningocele, lumbosacral lipomas, split cord malformation (diastematomyelia), meningoceles and some other neural tube defects. Split cord malformations with a fibrous, cartilaginous or bony band or spicule separating the spinal cord into hemicords, can occur as an isolated defect or either with a myelomeningocele or a lipomyelomeningocele. The occurrence of split cord malformations with lipomyelomeningocele is relatively rare in the pediatric neurosurgical practice. In this report, we present a one month old baby who had right leg monoparesis, with lipomyelomeningocele and split cord malformations with lipomyelomeningocele is relatively rare in the pediatric neurosurgical practice. Bir Split Kord Malformasyonu Tip I ve Lipomyelomeningosel Olgusu: Olgu Bildirimi Spina bifida terimi genellikle myelomeningosel, lumbosakral lipom, split kord malformasyonu (diastematomyeli), meningosel ve diger bazi noral tup defektlerini tanimlamak icin kullanilmaktadir. Split kord malformasyonu spinal kordun fibroz, kikirdak, kemik bant veya bir kemik spikul tarafindan iki hemikorda ayrilmasidir, bu malformasyon tek basina veya myelomeningosel veya lipomyelomeningosel gibi anomalilerle birlikte gorulebilir. Split kod malformasyonlari ve lipomyelomeningoselin birlikte gorulmesi pediatrik norosirurji pratiginde sik degildir. Bu yazida, sag bacak monoparezisi bulunan, lipomyelomeningosel ve split kord mal formasyonu tip Fi olan bir aylik bir bebek olgu sunulmaktadir.

Pediatrik Yaş Grubu Sivil Kranial Ateşli Silah Yaralanmaları

Pediatric Civilian Gunshot Wounds of the Cranium Pediatric civilian gunshot wounds of the cranium is relatively rare condition in the neurosurgical practice. The medical records of pediatric patients at our Neurosurgery Clinic (Ondokuz Mayis University, Medical Faculty, Department of Neurosurgery) treated for civilian gunshot wounds of the cranium were reviewed to determine the clinical, pathological and radiological features, and the outcome of these lesions. In total, 14 (8 boys and 6 girls) children were cared for between 1990 and 1996. The agressive surgical treatment (urgent craniotomy, meticulous wound debridment and the removal of all accessible bone and bullet fragments, as well as other foreign materials, decompression, and evacuation of the hematoma) were performed all patients exept six patients who in condition of neurological areflexic and respiratuar anest. 7 (%50) patients died. 3 (21%) patients with no neurological deficite, 2 (14%) patients with hemiplegic, and 2 (14%) patients with persistent vegetative state were discharged. The postoperative complications included scalp wound infection and subcutaneous cerebrospinal fluid leaks (One patient, 7% ), intracerebral apse (one patient, 7%), and subdural ampiyem (one patient, 7%). The agresslve surgical treatment of the gunshot wounds of the cranium is controversial, particularly the patient was brought deep comatose and unresponsive (areflexic) state. The prognostic factors included that the neurological state on arrival, radiological features, motivation for the shooting, and missile velocity. We have reviewed our experience over a period of 6 years wiur 14 pediatric patients. Our experience has led us to purpose a agressive operative approach for patients with a Glasgow coma score of 6 to 15 on arrival. The patients having bihemisphere injuries with a Glasgow coma score of 3 to 5 on arrival, and particularly when combined witti scattering of bone and metal fragments away from the bullet track, had worse prognose in our series. We believe that operative approach is unnecessary for patients having bihemisphere injuries with a Glasgow Coma Score of 3 to 5 on arrival, exept large defect of die scalp and skull Pediatrik yas grubu kranial atesli silah yaralanmalari norosirurji pratiginde sik karsilasilan durumlardan degildir. Ondokuz Mayis Universitesi Tip Fakultesi Norosirurji Kliniginde 1990-1996 yillan arasinda takip ve tedavi edilen 14 (8 erkek, 6 kiz) pediatrik sivil kranial atesli silah yaralanmasi olgusu bu tip olgularin klinik ve radyolojik bulgularii incelemek ve komplikasyonlanni ortaya koymak amaciyla retrospektif olarak yeniden gozden gecirilmistir. Arefleksik ve solunum arrestinde gelen 6 (%43) olgu disinda diger tum olgulara agressif cerrahi tedavi (acil kraniotomi, nekrotik beyin dokusu ve ulasilabilen kemik ve metal fragmanlarin temizlenmesi, dekompresyon, hematom bosaltilmasi ve duraplasti) uygulandi. 7 (%50) olgu exitus olurken, 3 (%21) olgu norolojik defisiti olmaksizin, 2 (%14) olgu hemiplejik, 2 (%14) olgu ise kronik bakim hastasi olarak taburcu edildi. 1 (%7) olguda yara yeri enfeksiyonu ve BOS fistulu, 1(%7) olguda int-raserebral apse, 1(%7) olguda da subdural ampiyem gelismistir. Kranial atesli silah yaralanmalarinin agressif cerrahi tedavisi ozellikle hasta ileri norolojik fonksiyon kaybiyla birlikte gelmisse tartismalidir. Tedavi sonucunu etkileyen faktorleri hastanin gelisteki norolojik durumu, radyolojik bulgular ve kursunun hareket yonu ve hizi seklinde siralamak olasidir. 14 pediatrik hastayi kapsayan alti yillik deneyimlerimiz derin koma disinda agressif cenahi tedavinin uygulanmasinin gerekliligini desteklerken, agir norolojik defisiti olan, radyolojik olarak iki hemisferi ilgilendiren, yr -kaplayan lezyonu olan, ve kafa icinde yabanci cisim bulunduran olgularin kotu prognoza sahip olduklanni gostermistir. Glasgow Koma Skala Skoru 5 ve altinda olan olgularda genis cilt ve kemik defekti olmadigi surece cerrahi tedavi uygulanmasinin herhangi bir yaran yoktur.

Paryetal Meningosel: Bir Olgu Sunumu

Eencephaloceles appear most often occipital and less nasal region. We presented a parietal encephalocele case cause of rarely localisation and reviewed the concerning literature Ensefaloseller cogunlukla oksibital ve daha az olarak nazal bolgede gorulurler. Bir paryetal ensefalosel olgusunu nadir gorulen yerlesimi dolayisiyla sunduk ve ilgili literaturu gozden gecirdik.

Kranial Ve Spinal Disrafizm

Cranial and spinal dysraphism ✓ In this study 87 patients who were ope.rated on with the diagnosis of carinal and spinal dysraphism between 1980-1990 in the Department of Neurosurgery, Ondokuz Mayls University Faculty of Medicine has been evaluated. As differentiated according to the type, 39 meningoceles (%45), 26 myelomeningoceles (%30), 1 diastematomyelia (%1»1) were consist¬ed. The majority of cases of dysraphism are associated with Arnold-Chiari Syndrome, lipom, hydrocephalus, scoliosis, genitorurinary and cardiovascular anomalies ✓ Bu calismada 1980-1990 yillan arasinda Ondokuz Mayis Universitesi Tip Fakultesi has¬tanesinde ameliyat edilen 87 Kranial ve Spinai disrafizmli olgular incelenmistir. Olgularin tip¬lerine gore ayiriminda, 39 meningosel (%45). 26 miyelomeningosel (%30), diastematomiyeli (%1,1), 6 frontalensefalosel (%6,9), 15 oksipital ensefalosel (17) icerdigi gorulmustur. Olgularin coguna Arnold-Chiari sendromu, lipom, hidrosefali,skolyoz, genitouriner ve kardiovaskuler anomalileri eslik ediyordu.