Objective: This study aimed to determine if the coronavirus disease 2019 (COVID-19) pandemic had any impact on admission patterns for subarachnoid hemorrhage (SAH) during 1st and 2nd waves and in-between in a tertiary institution in southeastern Turkey. Methods: Three periods were determined during the pandemic: First and second peaks (April 1-May 1, 2020 and November 18-December 18, 2020, respectively) and the slowdown period (July 5-August 4, 2020) where the daily new cases hit its lowest. We retrospectively collected data of the patients with SAH who were admitted to our institution within these periods during 2020 (the pandemic) and 2019 (the year before the pandemic). Demographic data, time between symptom onset and admission, Glasgow Coma Scale (GCS), Fisher score, World Federation of Neurosurgical Societies (WFNS), presence of intracerebral hemorrhage, intraventricular hemorrhage, hydrocephalus, type of SAH (aneurysmal vs non-aneurysmal) were recorded and compared between the pandemic and pre-pandemic periods. Results: The number of admissions in first peak, slowdown, and second peak during the pandemic was 11, 15, and 17, respectively. They did not differ significantly from corresponding periods in 2019 (17, 7, and 10, respectively) (all P>0.05). The mean time from onset to admission to hospital was similar between pandemic and 2019 (ranging between 0.40-2.00 days in 2020 compared to ranging between 1.12-2.29 days in 2019). The rate of cases with worse neurological condition on admission turned out to be lower during the first peak of the pandemic compared to previous year (9.1% vs 29.4%, P=0.029), but showed no difference in the remaining two periods. The incidence of accompanying pathologies (intracerebral hemorrhage, intraventricular hemorrhage, and hydrocephalus) was also similar between the periods in 2020 and their counterparts in 2019. Rate of non-aneurysmal cases ranged between 11.1%-45.5% in 2020 compared to 10.0%-57.1% in 2019 (all P>0.05). Conclusion: The study showed that hospital admission patterns for SAH was not affected by COVID-19 pandemic in the southeastern Turkey, unlike other reports. This may be due to different behavioral characteristics of the study population and capability of health care system to cope with high number of patient admissions.

Abstract Objective: Pontocerebellar angle (PCA) tumors, although typically of benign nature, are of significant clinical and pathological importance. The aim of this study is to investigate the clinical and pathological characteristics of PCA tumors, as well as surgical outcomes, which hold a significant place in clinical practice. Methods: 55 adult patients who underwent surgery for PCA tumors at the Department of Neurosurgery, Dicle University Faculty of Medicine, between 2013 and 2023 were included in the study. The clinical and pathological records of these patients were retrospectively reviewed. Results: The age of the patients (17 male, 38 female) ranged from 18 to 75 years. According to pathological diagnosis, 23 cases were diagnosed as meningioma, 19 as schwannoma, 6 as epidermoid tumors, 2 as metastases, 1 as hemangioblastoma, 1 as hemangioma, 1 as medulloblastoma, 1 as neuroblastoma, and 1 as small round cell tumor. Gross total resection was achieved in all cases. Overall, 47.3% of the patients had one or more postoperative complications. Postoperative permanent facial palsy developed in 6 patients. The overall mortality rate was 9%. Conclusion: Pontocerebellar angle tumors constitute a significant group among intracranial tumors. Surgical treatment is an important option for the management of these tumors. Primary goal of the surgery is gross total resection which is feasible in today. Though postoperative complications are common, majority of them is temporary.

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ÖZET Amaç: Bu çalışmada, hayatı tehdit eden komplikasyonlarla seyredebilen kraniyosinostoz nedeniyle ameliyat edilen çocuk hastalarda perioperatif anestezi yönetimini sunmayı amaçladık. Gereçler ve Yöntem: Ocak 2009-Ocak 2021 arasında opere edilen 26 kraniyosinostoz hastasının tamamının dosyasını geriye dönük olarak inceledik. Hastaların demografik verileri, ASA skorları, anestezi ve ameliyat süreleri, ek anomali koşulları, hava yolu ve kanama yönetimi ile komplikasyonları analiz edildi. Bulgular: Çalışmaya alınan 26 hastanın 16'sı trigonosefali, 4'ü skafosefali, 3'ü plajiyosefali ve 3'ü mikst tipte idi. Hastaların 20'si (%76.9) erkek, 6'sı (%23.1) kadındı. 26 hastanın beşinde (%19.23) ek anomaliler (1 Apert sendromu, 2 kardiyak anomali ve 2 hidrosefali) vardı. Ortalama ameliyat süresi 167.03 dk ve anestezi süresi 179.92 dk idi. Hastaların direkt laringoskopisinde CL skorları değerlendirildi. Beş hastada (%19.2) CL I, 13 hastada (%50.0) CL II ve 8 hastada (%30.8) CL III bulundu. Ameliyat sırasında 5 hastada (%19.23) şiddetli hipotansiyon gözlendi. Bu hastalara eş zamanlı kan ve sıvı infüzyonu ile 0.03 mg/kg/dk dozunda noradrenalin uygulandı. Ameliyat öncesi ortalama hematokrit değerleri %35.99, ameliyat sırasında %26.85 (0.001) olan hastaların preoperatif ve intraoperatif hematokrit değerleri arasında istatistiksel olarak anlamlı fark bulundu (p 0,001). Sonuç: Kraniosinostozlu pediatrik hastaların havayolu yönetiminin zor olduğunu ve intraoperatif masif kanama riski olduğunu saptadık. Bu hastalarda dikkatle planlanmış anestezi yönetimi gerekir. Anahtar Kelimeler: Kraniosinostoz, pediatrik hastalar, anestezi yönetimi, kanama yönetimi