Subdural haematoma as a rare complication of cochlear implantation: case report and literature review.

OBJECTIVE: To report a case of subdural haematoma occurring as an extremely rare and life-threatening complication of cochlear implantation, and to explore the causative association between intracranial haemorrhage and cochlear implantation surgical techniques. This association has not previously been reviewed in depth. CASE REPORT: A three-year-old boy was diagnosed with a large subdural haematoma, one week after cochlear implantation. After emergency evacuation of the haematoma, the patient made an excellent recovery and was discharged from hospital without any neurological deficit. RESULTS: Mechanisms of injury are discussed and the literature reviewed, focusing on the possible causes of intracranial haemorrhage identified after cochlear implantation. Notably, bone drilling had been used in all reported cases, and the probable causative injury had always occurred after such drilling. CONCLUSION: The issue of bone drilling during cochlear implantation is raised, and alternative methods of implant housing suggested, in order to avoid intracranial haemorrhage.

Civilian gunshot wounds to the head.

BACKGROUND AND PURPOSE: Civilian Gunshot Wounds (GSWs) to the head are important causes of mortality. The severity of GSWs is related to several factors. Patients with GSWs tend to do very well or very poor depending on these factors. METHODS: We retrospectively reviewed 47 patients with GSWs to the head during the last 5 years. Clinical and radiological findings of cases are described. Statistical analysis was used to find the effects of all independent variables with mortality and the prognostic factors. RESULTS: Glasgow Outcome Scale results showed that 38% of patients died, 13% were moderately disabled and 49% had good recovery at discharge. Patients with respiratory depression, hypovolemia, bilateral pupil dilatation, Glasgow Coma Scale (GCS) scores of 3 to 5, central bihemispheric and transventricular injury experienced 100% mortality. The mortality rate was 58% in patients with intracerebral or subdural hematoma, 78% in multilobar injury, 14% in unilobar injury and 57% in self-inflicted wounds. The postoperative mortality was 27%. CONCLUSION: The manuscript describes the clinical experience of penetrating missile injuries in a Turkish civilian practice. Mortality and/or poor outcome are relatively high in spite of the cases wounded by low-velocity weapons. We should emphasize that following stabilization of vital signs, all patients with GCS scores of 3 to 5 should be evaluated immediately with CT and treated conservatively. If it is appropriate the patients with a GCS score higher than 8 should undergo surgery. Patients with GCS scores of 6 to 8 should be followed closely and treated with surgery when necessary even if they have poor prognosis.

Enterocutaneous fistula: a complication of posterior iliac bone graft harvesting not previously described.

A case of enterocutaneous fistula at the donor site is presented. A patient underwent posterior C5-C6 wire fusion with autologous bone graft taken from the posterior superior iliac crest for degenerative C5-C6 spondylolisthesis. The tip of the osteotome slipped anteriorly during the procurement but neither neurovascular nor peritoneal injury were observed. Spillage of formed faecal material was observed from the donor site on the 12th postoperative day. Fistulogram showed an enterocutaneous fistula to descending colon. The fistula closed spontaneously in a week. Enterocutaneous fistula after bone harvesting has never been reported in the literature as far as we know. Congenital malformations and acquired causes may create a vulnerable peritoneal area. Small bowel or descending colon may show a close relationship or even an adhesion to peritoneum in the presence of local peritonitis. A small lesion in this area may play a role in the occurrence of a fistula, and a low flow pseudofistulous tract may appear. The thermal injury and possible ischaemic necrosis due to cauterisation may be predisposing factors in the aetiology of this kind of fistula. The lack of foreign material and spontaneous closure were against an infectious origin. The aims of this report are to present and analyse the reasons of this complication, not previously described.

Three unusual cases of intracranial hydatid cyst in the pediatric age group.

Three unusual cases of hydatid disease with central nervous system involvement are reported in the pediatric age group: a 9-year-old boy with a total number of 12 intracranial secondary hydatid cysts; a 13-year-old girl admitted in areflexia who survived after cyst puncture and successive mass removal, and a 14-year-old boy with a huge intracranial hydatid cyst weighing 770 g which was extracted without rupture. The article discusses the surgical problems, and the related literature is reviewed.