Kemali Baykaner

Observation of 95 patients with extradural hematoma and review of the literature

The authors review the cases of 95 patients with extradural hematoma managed at Gazi Hospital in the last 4 years. The common factors in craniocerebral traumas, the time interval between admittance and trauma, the interval between admittance and operation, and the location of hematomas are determined. The arterial origins demonstrated at operation in extradural hematomas are described. The interactions between all these factors and mortality are discussed. Availability of computed tomography scanning accounts for the present mortality rate of 9.4% when compared with the mortality rate of 33% for conventional diagnostic facilities.

Spinal cord compression due to brucella granuloma

SummaryCentral Nervous System (CNS) involvement during the course of Brucella infection is a rare clinical condition. In this article, a patient with a progressive paraparesis syndrome with spasticity, who was treated by medical methods and surgical intervention is analysed. This patient suffered from spinal cord compression in the thoracal region caused by a Brucella granuloma. The patient had no evidence of systemic Brucella infection.ZusammenfassungDie Brucella-Infektion führt nur selten zu einem Befall des Zentralnervensystems. Wir berichten über einen Patienten mit progressiver spastischer Paraparese, bei dem medikamentöse und chirurgische Maßnahmen erfolgten. Die Symptomatik beruhte auf einer Rückenmarkskompression im Thorakalbereich durch ein Brucella-Granulom. Es bestanden keinerlei Symptome einer systemischen Brucella-Infektion.

A New Coated Bipolar Coagulator: Technical Note

Summary Background. Sometimes charring or popping occurs and the bipolar blades get stuck to the vessel. Methods. The tips of one of the many commercially available bipolar forceps were coated in a striped manner with Teflon −50 μ in thickness. Results. The new bipolar coagulator coated with Teflon reduced the incidence of tissue sticking. Conclusions. Experience with this instrument was still quite limited, but preliminary results were promising.

Clinical significance of acute traumatic intracranial pneumocephalus

Among 1142 patients with head injuries hospitalized in the Neurosurgery Department of Gazi University Medical School during the period between 1979 and 1992, 583 had initial CT scans. A retrospective analysis of these initial CT images revealed intracranial air on admission in only 21 cases. These were classified as acute traumatic intracranial pneumocephalus: a potentially serious complication of head injury.CT scans were re-evaluated so as to reveal whether air was situated in the epidural, subdural, or subarachnoid spaces or intracerebrally; whether associated space-occupying lesions were present; and whether the air bubbles were single or multiple. Clinical data such as the presence of persistant rhinorrhea and/or otorrhea, tension pneumocephalus, severity and type of trauma, and outcome were also assessed to determine the significance of this rare finding.

Early phase alterations in endothelium dependent vasorelaxation responses due to aneurysm clip application and related manipulations

SummaryMechanically induced vasoconstriction observed throughout surgery and in the immediate postoperative period was investigated to assess the effects of various microsurgical manipulations.Factors such as the type of aneurysm clip, duration of temporary clipping and peri-adventitial tissue stripping were the variables in this study. Microsurgical clips were applied on guinea pig “cervical carotid arteries” in which peri-adventitia had been removed microsurgically. Arterial rings were removed immediately after surgery. Endothelium dependent relaxations were measured and morphological investigations were performed using light microscopy.It was observed that as the clip application period increased, relaxation responses decreased. Peri-adventitial tissue stripping caused a marked decrease in the relaxation responses in all types of the clips. Microvascular clips, in spite of their lower closing forces, had the greatest deleterious effect on relaxation responses of the vessel, in both normal and peri-adventitial tissue stripped. When the peri-adventitial tissue of the vessel had been stripped, convolutions of the lamina elastica interna were found to be lost in parallel with the decreased tonus of the artery. In the vessels subjected to clipping endothelial denudation and cracking took place.As a conclusion it can be stated that both peri-adventitial tissue stripping and microvascular clip application have deleterious effects in the early postoperative period. While choosing clips from minimal occlusion force tables, care must be taken to choose clips with less width; and while performing microvascular anastomosis, temporary clips with a lesser width must be used in place of microvascular clips. Adventitial stripping must not be unnecessarily generous during microvascular anastomosis.

Split-cord malformation and tethered cord associated with immature teratoma

Case reportWe report a case of a 12-month-old boy with split-cord malformation, tethered cord, and intradural immature teratoma containing immature nephroblastic tissue. He also had a horseshoe kidney. OutcomeSurgical removal of the teratoma and tethered cord resulted in functional improvement of the existing bladder dysfunction. DiscussionTo our knowledge, such a case has not been reported before.

Fractionated gamma knife radiosurgery for optic nerve tumors: a technical report.

AIM The main purpose of this report is to demonstrate the effects of fractionated radiosurgery regimens in the management of optic gliomas MATERIALS and METHODS Two patients suffering from progressive loss of vision due to optic nerve gliomas were treated with Gamma Knife radiosurgery in three fractions within three consecutive days instead of a single dose regimen. Patients were followed for 42 and 39 months respectively. RESULTS The treatment modality was well tolerated by the patients with radiological and neurological tumor control after 42 and 39 months of follow up. There were no additional complications. CONCLUSION Fractionated regimens of Gamma Knife surgery offer a very good alternative for lesions such as optic glioma and optic nevre sheath meningioma.

Hypothalamic lipoma adjacent to mamillary bodies.

Abstract Introduction. Intracranial lipomas are rare lesions of developmental origin. They are generally asymptomatic and localized in the midline. However, they may occasionally produce neurological symptoms such as seizures. Surgical treatment is rarely indicated. Case report. We report a child with a lipoma that is located on the ventral side of the mamillary bodies. The diagnosis was made using computerized tomography (CT) and magnetic resonance imaging (MRI). There have been no previous reports of lipomas in this location.

Giant meningioma in a fourteen-month-old infant

Abstract A case of giant meningioma in a 14-month-old infant is presented and pathologic characteristics of such lesions are reviewed.

Sella turcica fractures in a trauma series and their clinical significance

BACKGROUND Fractures in the region of the sella turcica (ST) are usually associated with severe blunt head trauma and may produce many complications. The true incidence is difficult to assess since there have been only about 30 cases reported in the literature. METHODS A total of 470 computed tomography (CT) sections--with optimum bone window images of skull bone--of 1600 head trauma patients who were admitted between 1979 and 1992, inclusive, to the Neurosurgery Department of Gazi University Medical School were analyzed retrospectively. RESULTS There were a total of 17 patients with a fracture of the ST, constituting an incidence of 3.6%, and there was a preponderance of children. CONCLUSIONS Computed tomography was very helpful in assessing the extent of ST fractures. In our cases, these fractures were not associated with a high complication or death rate, although a cerebrospinal fluid fistula was present in 53%.