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.
and cranial bones. Today, posterior fossa decompression is the most common surgical treatment method for CMI. In this study, we conducted clinical and radiological comparisons in 78 patients with CMI undergoing dural splitting and 35 patients with CMI undergoing duraplasty. Clinical evaluation and physical examination were performed at specific periods in the patients. In addition, as per our knowledge, this is the first study discussing the relationship between tonsillo-dural distance (TDD) and the syrinx cavity. Furthermore, the utility of intraoperative ultrasonography (USG) in cases requiring dural splitting was demonstrated. █ INTRODUCTIONT ype I Chiari malformation (CMI) is characterized by cerebellar tonsil herniation through the foramen magnum into the cervical spinal canal (2,3). Although 30% of patients are asymptomatic, progressive and severe neurological deficits are also observed (13,14). Clinical findings usually appear in the third and fourth decades of life. Magnetic resonance imaging (MRI) is the gold standard test for diagnosing CMI. Computed tomography and X-ray images are important for evaluating accompanying anomalies of vertebrae 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.To watch the surgical videoclip, please visit
The majority of CSF leaks are posttraumatic (80%) or postoperative/iatrogenic (16%) and only 4 % are spontaneous (2). Spontaneous or primary CSF fistulas have been accepted as a different entity, seen in patients without any known etiologic factors such as a tumor, trauma or congenital anomalies. It is generally seen in the middle-aged obese women (10,20).In the presence of a nasal secretion and a suspicion of CSF leak, the nasal fluid must be examined for the possibility of CSF. For this purpose, diagnostic procedures based on structural differences of bodily fluids are used in certain █ INTRODUCTION C erebrospinal fluid (CSF) leak or cerebrospinal fistula is a medical condition described first by St. Clair Thompson, in which the CSF leaks out of intracranial cavity due to the presence of defects in the dura on the skull base (1). It suggests a laceration or defect in the dura, arachnoid and pia mater, causing a communication between intracranial cavity and nasal or tympanic cavity (13). Cribriform plate is the area where CSF leak often occurs, followed in terms of frequency by sella, sphenoid, ethmoid and frontal sinuses (7,29). 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.
ABSTRACTare used in an attempt to keep the body temperature stable and it may be monitored continuously by a probe. However, it is nearly impossible to objectively evaluate the amount of bleeding in the calvarium while undergoing a barrel stave osteotomy. Therefore, the intraoperative observations of the surgeon, his experience, and his communication with the anesthetist and monitoring of vital signs are important in determining perioperative blood and fluid losses (13).Our aim was to evaluate blood loss and administration of blood products in patients being operated on to treat craniosynostosis, while taking age, body weight, type of craniosynostosis, preoperative and postoperative hemoglobin and hematocrit levels in to consideration. █ INTRODUCTION C raniosynostosis is the early and pathologic closure of one or more sutures in the cranium, generally causing an abnormal appearance (21). Although craniosynostosis cases are referred to a physician for cosmetic reasons, the main aim of neurosurgeons in treating craniosynostosis is to relieve an increase in potential intracranial pressure on the neural tissues and prevent and or treat disorders of cognitive function. Thus, a widely used procedure in neurosurgery, barrel stave osteotomy, is applied to the majority of craniosynostosis cases. Hypothermia and hypovolemia are the most important causes of morbidity and mortality in surgical interventions of craniosynostosis (18). During surgery, heating blankets 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 1 st and 6 th hours and cases with hemoglobin levels below 10 or with hematocrit levels which had decreased more than 5% between the 1 st and 6 th 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 i...
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