Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36
Filtrar
1.
Pediatr Neurosurg ; 58(3): 173-178, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37231851

RESUMO

INTRODUCTION: Extraskeletal myxoid chondrosarcoma of the jugular foramen is a rare clinical entity, especially in the pediatric population. Thus, it can be confused with other pathologies. CASE PRESENTATION: We report an extremely rare case of a 14-year-old female patient with jugular foramen myxoid chondrosarcoma that was completely removed through microsurgical resection. CONCLUSION: The primary purpose of the treatment is gross total resection of the chondrosarcomas. However, adjuvant methods such as radiotherapy should additionally be applied in patients who have high-grade diseases or cannot undergo gross total resection because of anatomic localization.


Assuntos
Condrossarcoma , Forâmen Jugular , Neoplasias de Tecido Conjuntivo e de Tecidos Moles , Feminino , Humanos , Criança , Adolescente , Forâmen Jugular/patologia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/cirurgia , Condrossarcoma/patologia , Neoplasias de Tecido Conjuntivo e de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecido Conjuntivo e de Tecidos Moles/cirurgia
2.
Childs Nerv Syst ; 38(7): 1377-1380, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34595587

RESUMO

INTRODUCTION: Central nervous system xanthogranulomas are uncommon clinical entities, and symptomatic bilateral choroid plexus xanthogranulomas are rare. CASE PRESENTATION: We present the case of a 15-year-old male patient with bilateral choroid plexus xanthogranulomas with symptoms of increased intracranial pressure. Gross total resection of the tumor in the left lateral ventricle was performed. The patient improved, and asymptomatic right-sided tumor was monitored at follow-up. CONCLUSION: The main treatment objective in these tumors is gross total resection. Asymptomatic tumors can be followed without intervention. However, surgery should be performed for symptomatic tumors that cause hydrocephalus or symptoms of increased intracranial pressure.


Assuntos
Neoplasias do Plexo Corióideo , Hidrocefalia , Hipertensão Intracraniana , Xantomatose , Adolescente , Criança , Plexo Corióideo/diagnóstico por imagem , Plexo Corióideo/patologia , Plexo Corióideo/cirurgia , Neoplasias do Plexo Corióideo/diagnóstico por imagem , Neoplasias do Plexo Corióideo/patologia , Neoplasias do Plexo Corióideo/cirurgia , Granuloma/diagnóstico por imagem , Granuloma/patologia , Granuloma/cirurgia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Hipertensão Intracraniana/patologia , Ventrículos Laterais/patologia , Masculino , Xantomatose/complicações , Xantomatose/diagnóstico por imagem , Xantomatose/cirurgia
3.
Pediatr Int ; 65(1): e15398, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36305209

RESUMO

BACKGROUND: Enterococcal infections are increasingly common in hospitalized patients. Enterococcal meningitis/ventriculitis (EMV) is an extremely rare condition of enterococcal infections, occurring particularly in children. This study investigated the clinical and microbiological characteristics, predisposing factors, and prognosis in pediatric patients with EMV. METHODS: Pediatric patients (<18 years) diagnosed with EMV were retrospectively evaluated over 10 years. RESULTS: The study included a total of 25 isolates from 24 patients, median age 23 months (range: 1-136 months). The most common symptoms included vomiting, fever, and headache, with hydrocephalus shunt and preterm birth being the two most common conditions. Commonly associated infections, with central nervous system (CNS) devices as a predisposing factor, were due to external ventricular drainage and ventriculoperitoneal shunts. Two patients with spontaneous meningitis were preterm infant. Of the isolates, 44% were Enterococcus faecalis, 44% E. faecium, and 12% E. gallinarum. Five (20%) isolates were vancomycin resistant. Twelve patients were resistant to anti-enterococcal antibiotics, including ampicillin, ciprofloxacin, imipenem, teicoplanin, gentamicin, and linezolid (40%, 20%, 8%, 8%, 4%, and 4%, respectively). Enterococcus faecium was more resistant to ampicillin, ciprofloxacin, teicoplanin, and vancomycin than E. faecalis. The median treatment duration was 17 days (interquartile range: 14-26 days).The mortality rate was 8.3% (2/24; both associated with vancomycin resistance). CONCLUSIONS: Neurosurgical conditions are the most common predisposing factors for EMV. Preterm birth is an important predisposing factor in children. Because EMV is nonspecific in clinical findings, it should be considered when there is an underlying CNS disorder and empirical treatment should begin in this direction.

4.
Childs Nerv Syst ; 37(10): 3241-3244, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33523244

RESUMO

INTRODUCTION: Pituitary abscess is a rare lesion of the pituitary gland that can cause morbidity and mortality in the absence of appropriate treatment. They are classified as primary and secondary pituitary abscesses. Primary pituitary abscesses occur in patients with no previous pituitary pathology. Secondary pituitary abscesses are detected in patients with existing pituitary pathologies. CASE PRESENTATION: We report a 16-year-old female patient with primary pituitary abscess who was misdiagnosed initially and treated as meningitis. Following the visual disturbances, pituitary abscess was diagnosed, and she underwent abscess drainage via endoscopic endonasal transsphenoidal surgery and antibiotic treatment. CONCLUSION: Primary pituitary abscess can be clinically confused with other pathologies affecting the central nervous system. In order to avoid permanent sequelae in such patients, it should be kept in mind by physicians in similar cases. Satisfying results are obtained in these patients after appropriate treatment and dramatic improvement is achieved.


Assuntos
Abscesso Encefálico , Meningite , Doenças da Hipófise , Neoplasias Hipofisárias , Adolescente , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/cirurgia , Criança , Endoscopia , Feminino , Humanos , Doenças da Hipófise/diagnóstico , Hipófise/diagnóstico por imagem
5.
Childs Nerv Syst ; 37(1): 229-233, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32666153

RESUMO

PURPOSE: Of the many suggested techniques, we used dorsal intercostal perforator artery flap (DIPAF) for the closure of myelomeningocele defects. This study compared the outcomes of primary closure and DIPAF in the closure of myelomeningoceles. METHODS: Data of 24 patients that underwent myelomeningocele surgery at a single institution between November 2015 and September 2019 were retrospectively reviewed. RESULTS: The primary closure group had 13 patients (54.17%) and the DIPAF group had 11 (45.83%). The mean age was 7.91 ± 13.27 days (1-60 days). Twelve patients were female and 12 were male. In 22 patients, the myelomeningocele sacs were in the lumbosacral region, while in 2, they were in the thoracolumbar region. The mean defect sizes were 14.20 ± 4.62 cm2 and 18.44 ± 3.49 cm2 in the primary closure and DIPAF groups, respectively. In each group, four patients had a kyphotic deformity. In the primary closure group, three patients had wound necrosis, two had wound dehiscence, and four had cerebrospinal fluid (CSF) leakage. In the DIPAF group, one patient had wound necrosis and one had CSF leakage. Significantly fewer complications related to the operation area were observed in the DIPAF group (p < 0.05). Increased defect size, kyphotic deformity, and presence of hydrocephalus were found to be risk factors for complications related to the operation area. CONCLUSION: This surgical treatment protects neural tissue, prevent CSF leakage, and reduce central nervous system infection rates in myelomeningocele patients. Closure technique with the fasciocutaneous skin flap has more satisfying results than primary closure.


Assuntos
Meningomielocele , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Adolescente , Adulto , Artérias , Criança , Feminino , Humanos , Masculino , Meningomielocele/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Pediatr Neurosurg ; 56(3): 300-305, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33853073

RESUMO

INTRODUCTION: Extraneural metastases of glioblastoma are very rare clinical entities, especially in pediatric patients. Because of their rarity, they can be confused with other pathological processes. CASE PRESENTATION: We report a case of 16-year-old boy with extensive extraneural metastases of glioblastoma. Lung, liver, cervical lymph nodes, skin, and bone metastases were detected in the patient. CONCLUSION: We describe the presentation, evaluation, and diagnosis of this rare condition with regard to pertinent literature.


Assuntos
Neoplasias Ósseas , Neoplasias Encefálicas , Glioblastoma , Neoplasias Supratentoriais , Adolescente , Neoplasias Encefálicas/diagnóstico por imagem , Criança , Glioblastoma/diagnóstico por imagem , Humanos , Masculino
7.
Pediatr Neurosurg ; 55(2): 101-105, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32683366

RESUMO

BACKGROUND/AIMS: We aimed to evaluate the course of urinary problems in children with spinal dysraphism. METHODS: This multicenter study evaluated data on pediatric patients diagnosed with spinal dysraphism between 2010 and 2019. The neurological and urological conditions of the patients were examined retrospectively. This study focused on the course of urological problems. Urodynamic examinations including urodynamic bladder capacity, bladder pressure in maximal capacity, compliance, detrusor hyperactivity, uroflowmetry, and residual urine amount were evaluated. All patients underwent urinary system ultrasonography, urinalysis, hemogram and biochemical tests, and urodynamics at admission and follow-ups. RESULTS: A total 62 patients (35 males, 27 females) with a mean age of 7.50 ± 4.01 years and age range of 1-16 years were included in the study. Ultrasonographic evaluation revealed normal results in 32 patients and abnormal findings, including moderate-to-severe calyceal dilatation, parenchymal thinning, and residual urine, in 30 patients. At the time of diagnosis, culture-positive urinary tract infection was detected in 22 patients, and leukocyte and/or bacterial positivity was detected in 18 patients. The differences between bladder capacity, bladder pressure at maximal capacity, compliance, and detrusor hyperactivity at first admission and post-treatment were statistically significant (p < 0.05). Vesicoureteral reflux was also detected in 25 patients. Thirty patients underwent oral anticholinergic and antibiotic prophylaxis, while 17 additionally underwent clean intermittent catheterization. Five patients underwent intravesical Botox injection, clean intermittent catheterization, and medical treatment, and 10 patients underwent augmentation cystoplasty. CONCLUSION: The prevalence of urinary tract problems is high in patients with spinal dysraphism for whom early diagnosis is very important for both urologic and neurosurgical considerations. Early follow-up of urodynamics should be performed, and treatment should be carried out if necessary. Regular follow-up and appropriate treatment have positive effects on the quality of life of these patients and may also prevent the occurrence of severe renal dysfunction.


Assuntos
Disrafismo Espinal/diagnóstico por imagem , Disrafismo Espinal/epidemiologia , Doenças da Bexiga Urinária/diagnóstico por imagem , Doenças da Bexiga Urinária/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Fatores de Tempo
8.
Pediatr Neurosurg ; 55(5): 289-294, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33171459

RESUMO

INTRODUCTION: Thymic carcinoma metastases of the spinal column are very rare, especially in pediatric patients. To our knowledge, this is the first such pediatric case in the literature. CASE PRESENTATION: We report the case of a 14-year-old male patient with T12 and L1 metastases of thymic carcinoma. He had history of thymectomy and intrathoracic tumor resection 7 months previously. The patient's neurological condition deteriorated; therefore, tumor resection and decompression of the spinal canal were performed. He underwent instrumentation and fusion procedures to prevent spinal instability. CONCLUSION: The main purpose of the treatment is gross total resection of the thymic carcinoma. However, adjuvant methods such as radiotherapy and chemotherapy should be added to the treatment protocol in patients who have higher stage diseases or those in whom total tumor resection cannot be achieved.


Assuntos
Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adolescente , Humanos , Masculino , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem
9.
Childs Nerv Syst ; 35(3): 553-557, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30259086

RESUMO

INTRODUCTION: Giant cell tumors of the mobile spinal column are very rare tumors, especially in the pediatric age group. Although they are benign tumors, they have locally aggressive growth pattern and high risk of recurrence. CASE PRESENTATION: We report a 15-year-old female patient with thoracic giant cell tumor who underwent percutaneous vertebroplasty and had cement extravasation into the spinal canal. Because of the deterioration of the patient's neurological condition, total enbloc spondylectomy and cement excision were performed. She underwent instrumentation and fusion procedures in order to prevent spinal instability. CONCLUSION: The main purpose of the treatment is gross total resection of the giant cell tumor. However, adjuvant methods such as denosumab should be added to the treatment protocol in patients who are older than 2 years old and can not undergo gross total resection due to tumor size and anatomic localization.


Assuntos
Cimentos Ósseos/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Tumor de Células Gigantes do Osso/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Vertebroplastia/efeitos adversos , Adolescente , Descompressão Cirúrgica/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/cirurgia , Feminino , Tumor de Células Gigantes do Osso/patologia , Humanos , Fusão Vertebral/métodos , Neoplasias da Coluna Vertebral/patologia , Vértebras Torácicas
10.
Childs Nerv Syst ; 35(4): 629-636, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30687902

RESUMO

PURPOSE: Ventriculitis is known to develop after chronic inflammation and bacterial invasion of the ventricular surface with a recurrence of shunt infections. The aim of this study is to evaluate the diagnostic value of elevation in cerebrospinal fluid (CSF) interleukin-1 beta (IL-1ß) and tumor necrosis factor alpha (TNF-α) together with CSF culture and laboratory test results in the diagnosis of ventriculoperitoneal (VP) shunt-related ventriculitis, which is known to be more problematic than conventional shunt infection. METHODS: The study included a total of 34 patients with a VP shunt due to hydrocephalus, who presented with a headache, fever, and shunt infection at the Emergency Department and had a pre-diagnosis of ventriculitis. Nineteen patients were diagnosed with shunt-related infection or ventriculitis using the CSF obtained from the shunt pump. The IL-1ß and TNF-α levels from the CSF samples of all patients were measured using the Micro ELISA immunoassay method. RESULTS: CSF direct microscopic observation revealed that the mean cell count, IL-1ß level, CRP level, and blood leukocyte level were higher in patients with ventriculitis compared to those diagnosed with shunt infection (p = 0.02, p = 0.009, p = 0.004, and p = 0.009, respectively). The probability of predicting positive culture outcome was 92.7% with 90.9% sensitivity and 82.6% specificity when IL-1ß values exceeded 4.0 pg/ml. TNF-α values did not show a significant, reliable pattern compared to IL-1ß. CONCLUSIONS: IL-1ß is a reliable parameter which shall be used in the diagnosis of ventriculitis by predicting positive culture outcome with high sensitivity and specificity.


Assuntos
Biomarcadores/líquido cefalorraquidiano , Ventriculite Cerebral/diagnóstico , Interleucina-1beta/líquido cefalorraquidiano , Fator de Necrose Tumoral alfa/líquido cefalorraquidiano , Derivação Ventriculoperitoneal/efeitos adversos , Adulto , Ventriculite Cerebral/líquido cefalorraquidiano , Ventriculite Cerebral/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
11.
Pediatr Neurosurg ; 54(1): 28-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30673675

RESUMO

OBJECTIVE: To evaluate pediatric patients who were operated with the diagnosis of depressed skull fracture. METHODS: The records of pediatric patients who presented with traumatic head injury to multicenter neurosurgery clinics between 2002 and 2018 and who were operated with a diagnosis of depressed skull fracture were retrospectively reviewed. All of the patients underwent primary bone fragment replacement operation, and the patients' own bone flaps were used to repair depressed skull fractures in all of them. RESULTS: A total of 78 patients were included in the study. Of the study group, 20 patients presented with mild head injury, 37 had moderate head injury, and 21 had severe head injury. Dural injury was present in 67 patients (86%) and the dura was intact in 11 patients (14%). After surgery, 63 patients (81%) had good outcome, 8 patients (10%) had moderate disability, and 5 patients (6.5%) had severe disability. Two patients with multiple accompanying cranial pathologies died and the mortality rate was 2.5%. Infection was detected in only 2 of the 78 patients who were treated within the first 72 h after trauma. One of them had meningitis and the other skin infection. Both patients were treated with appropriate antibiotherapy. None of the patients in the study group had an infection involving the bone, such as osteomyelitis, or the tissues under the bone, such as subdural-epidu-ral empyema or abscess. None of the patients required reoperation and removal of the bone. CONCLUSION: In the present study, as the pathologies accompanying the depressed skull fractures of the patients increased, Glasgow Coma Scale scores at arrival and Glasgow Outcome Scale scores at discharge decreased. Regardless of whether the depressed fracture is simple or compound, primary bone fragment replacement with appropriate decontamination of the fractured bone and operation area via single-session intervention gives good results. It is important to perform the surgery as soon as possible to reduce the risk of contamination. Primary bone fragment replacement seems to be an appropriate treatment option for depressed skull fractures.


Assuntos
Transplante Ósseo/métodos , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fratura do Crânio com Afundamento/cirurgia , Adolescente , Transplante Ósseo/tendências , Criança , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
Pediatr Neurosurg ; 53(3): 171-174, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29635239

RESUMO

Cervical myelopathy caused by invaginated laminae of the axis is an extremely rare entity. Advanced imaging techniques are useful to define this rare pathology and site of the spinal canal compression. Surgical removal of the floating laminae is commonly an adequate treatment method. Fusion procedures should be added in the presence of instability. There are few cases of invaginated anomalous laminae of the axis in the literature. In this report, to the best of our knowledge having reviewed the literature, the youngest and first female patient is presented.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia , Canal Medular , Compressão da Medula Espinal/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Criança , Descompressão Cirúrgica , Feminino , Humanos , Imageamento por Ressonância Magnética , Cervicalgia/etiologia , Canal Medular/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
Pediatr Neurosurg ; 52(5): 323-326, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28817819

RESUMO

Posterior vertebral column resection is a novel surgical approach for the treatment of progressive kyphosis associated with tethered cord syndrome that was first treated with untethering surgery. A patient with tethered cord syndrome associated with kyphosis first underwent untethering surgery, resulting in progressive kyphosis. Posterior vertebral column resection was performed to correct the kyphosis while shortening the spinal column to prevent the spinal cord from stretch injury. Good correction of kyphosis and reduction of tension on the neural elements were achieved without any neurological deficits. In progressive kyphosis associated with tethered cord syndrome, posterior vertebral column resection after untethering surgery represents a safe and efficacious but technically challenging option.


Assuntos
Progressão da Doença , Cifose/cirurgia , Defeitos do Tubo Neural/cirurgia , Procedimentos Neurocirúrgicos/métodos , Parafusos Pediculares , Criança , Humanos , Cifose/diagnóstico por imagem , Cifose/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/diagnóstico por imagem , Procedimentos Neurocirúrgicos/instrumentação , Parafusos Pediculares/estatística & dados numéricos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
14.
Pediatr Neurosurg ; 52(1): 30-35, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27427970

RESUMO

Cavernous malformations (CMs) of the central nervous system are benign, angiographically occult vascular lesions and are diagnosed by magnetic resonance imaging techniques. Giant CMs do not differ from smaller-sized CMs in their clinical, surgical or histopathological presentation but may be radiologically different. In this paper, we report a 10-year-old male with a giant CM of 8 × 7.5 × 7 cm in diameter that was completely removed by microsurgical treatment. This case addresses important points for practicing neurosurgeons to consider when making a differential diagnosis of large intracranial mass lesions in pediatric patients. In this report, the radiological features of this vascular malformation are described based on a pertinent literature review.


Assuntos
Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Criança , Humanos , Masculino
15.
Pediatr Neurosurg ; 50(6): 336-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26458143

RESUMO

Ventriculoperitoneal shunt surgery is the most frequently performed procedure in the management of hydrocephalus. Many varied complications related to this procedure have been reported. Distal migration of the peritoneal catheter and extrusion from the intact skin in an area unrelated to the surgical incision constitute a rare complication. We report a 1-year-old patient with the extrusion of the peritoneal catheter from the intact skin in the right lumbar region and present a literature review.


Assuntos
Catéteres/efeitos adversos , Falha de Equipamento , Migração de Corpo Estranho/complicações , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Humanos , Lactente , Região Lombossacral , Masculino
16.
World Neurosurg ; 186: e251-e260, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38537788

RESUMO

OBJECTIVE: Basilar invagination is one of the most frequently observed abnormalities at the craniovertebral junction, in which the odontoid process of C2 prolapses into the foramen magnum. METHODS: The current study included 27 patients who underwent surgery for basilar invagination between October 2013 and January 2023. The study group was divided into 2 groups according to basilar invagination types; type I (the presence of type A atlantoaxial instability and instability is the main pathology) and type II (the presence of type B and C atlantoaxial instability and skull base dysgenesis is the main pathology). Craniometric parameters included in the study were atlantodental interval, posterior atlantodental interval, Chamberlain's line violation, clivus-canal angle, Welcher's basal angle, and Boogaard angle. RESULTS: The mean age of the patients was 24.30 ± 14.36 years (5-57 years). Fourteen patients (51.9%) were female, and 13 patients (48.1%) were male. Ten patients (37%) had type I basilar invagination, and 17 patients (63%) had type II basilar invagination. Preoperative and postoperative atlantodental interval and Boogaard angle were significantly higher in type I basilar invagination, as preoperative and postoperative posterior atlantodental interval and clivus-canal angle were significantly higher in type II basilar invagination. There was a positive strong correlation between Chamberlain's line violation and Boogaard angle. Postoperative Chamberlain's line violation was significantly higher in occipitocervical fixation (P = 0.035). C1 lateral mass screw fixation was found more successful in Chamberlain's line violation correction than occipital plates. Occipitocervical fixation was found to be associated with higher postoperative Nurick scores (P = 0.015) and complication rates (P = 0.020). Cages applied to the C1-C2 joint space were found to be associated with higher fusion rates (P = 0.023) and lower complication rates (P = 0.024). CONCLUSIONS: In the present study, it was found that C1-C2 fixation was more successful in correcting craniometric parameters and had lower complication rates than occipitocervical fixation. In appropriate patients, it was determined that cage application increased the success rates of the operations.


Assuntos
Articulação Atlantoaxial , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adolescente , Criança , Adulto Jovem , Pré-Escolar , Resultado do Tratamento , Articulação Atlantoaxial/cirurgia , Cefalometria/métodos , Instabilidade Articular/cirurgia , Processo Odontoide/cirurgia , Processo Odontoide/diagnóstico por imagem , Forame Magno/cirurgia , Estudos Retrospectivos , Fusão Vertebral/métodos
17.
Turk Neurosurg ; 34(2): 325-330, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38497186

RESUMO

AIM: To identify the patterns and types of neuorosurgical injuries sustained by victims of the double earthquakes affected ten cities with a population of 15 million in southern and central Türkiye. MATERIAL AND METHODS: In this descriptive observational study, we retrospectively analyzed the medical records of a university hospital located in one of the ten cities affected by the earthquake. RESULTS: A total of 1,612 patients with earthquake-related injuries were admitted during the study period, of which 139 (8.6%) had neurosurgical injuries. The mean age of the patients was 42.4 ± 21.1 years (median, 42 years), and 53.2% of them were female. Of the 139 patients with neurosurgical injuries, 41 (29.5%) had craniocerebral injuries, 95 (68.3%) had spinal injuries, and three (2.2%) had both craniocerebral and spinal injuries. A total of 31 surgeries were performed (22.3%) (five [3.6%] for craniocerebral injuries and 26 [18.7 %] for spinal injuries). Ninety-eight patients (70.5%) had concomitant systemic traumas. The overall mortality rate was 5.75%, with crush syndrome (n=4, 50%), being the leading cause of death, followed by neurosurgical pathologies (n=3, 37.5%) and pneumonia with septic shock (n=1, 12.5%). CONCLUSION: Neurosurgical injury is an important cause of post-earthquake mortality and morbidity. To ensure efficient medical rescue and judicious resource allocation, it is essential to recognize the characteristics of earthquake-related neurosurgical injuries. This study provides valuable information regarding the incidence, characteristics, and outcomes of neurosurgical injuries in earthquake-affected patients. Our findings highlight the need for prompt diagnosis and management of such injuries, particularly in those with concomitant systemic trauma.


Assuntos
Traumatismos Craniocerebrais , Terremotos , Traumatismos da Coluna Vertebral , Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Masculino , Turquia/epidemiologia , Estudos Retrospectivos , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/cirurgia , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/cirurgia
18.
Turk Neurosurg ; 34(3): 423-428, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38650557

RESUMO

AIM: To evaluate the efficacy of percutaneous ventriculoatrial shunting as a salvage method for pediatric patients with abdominal complications. MATERIAL AND METHODS: Data obtained from 9 patients with ventriculoperitoneal shunt dysfunctions owing to abdominal complications, who underwent ventriculoatrial shunting as salvage treatment at a single institution between January 2019 and September 2021 were retrospectively analyzed. All operations were conducted under the guidance of intraoperative fluoroscopy and ultrasound. RESULTS: The mean age of the enrolled patients was 8.1 ± 1.2 years (2-15 years). Six (67%) patients were male and 3 (33%) were female. The mean number of the patients? ventriculoperitoneal shunt revisions until atrial catheter placement was 7.5 times. The reasons for intraperitoneal catheter failure included peritoneal adhesions in 4 (44.5%) patients, pseudocyst formation in 3 (33.3%), and peritonitis in 2 (22.2%). Seven patients from the study cohort had no problem after ventriculoatrial shunt placement. Only 1 patient had shunt dysfunction related to the ventricular catheter, and ventricular catheter and shunt valve revision was performed 26 months after ventriculoatrial shunt placement. The atrial catheter of the patient was intact. One patient died from the progression of her primary disease (medulloblastoma in the 4 < sup > th < /sup > ventricle), which was unrelated to the ventriculoatrial shunt. CONCLUSION: Percutaneous ventriculoatrial shunting under the guidance of intraoperative fluoroscopy and ultrasound is a safe, effective, and easy alternative in patients with peritoneal complications and a history of multiple operations.


Assuntos
Hidrocefalia , Derivação Ventriculoperitoneal , Humanos , Feminino , Hidrocefalia/cirurgia , Hidrocefalia/etiologia , Criança , Masculino , Pré-Escolar , Adolescente , Derivação Ventriculoperitoneal/métodos , Estudos Retrospectivos , Terapia de Salvação/métodos , Resultado do Tratamento , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos
19.
J Neurol Surg B Skull Base ; 85(3): 318-324, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38721360

RESUMO

Objectives Postoperative cerebrospinal fluid (Po-CSF) leak is still a challenging complication of endoscopic endonasal skull base surgery. However, data describing the predictive factors of Po-CSF leak in pure pituitary adenomas is lacking. Aim of this study is to determine the risk factors of Po-CSF leak in a pituitary adenoma group operated via pure transsellar endoscopic approach. Design This is a retrospective cohort study. Setting A single-center academic hospital. Participants Patients operated for a pituitary adenoma between 2015 and 2021 and followed up until June 2022 were included. Main Outcome Measures Demographics, comorbidities, imaging, and outcome were recorded. Univariate and multivariate logistic regression analyses were used to determine the risk factors of Po-CSF leak. Results Of the total 170 patients with a mean age of 47.5 ± 13.8 (min: 15; max: 80), 11 (6.5%) had Po-CSF leak. Univariate analysis revealed age, diabetes mellitus (DM), and tumor volume as predictors of Po-CSF leak. According to the receiver operating characteristic analysis, 7.5 cm 3 of tumor volume was found to be a good cutoff value with a sensitivity of 82% and a specificity of 75%. Hence, multivariable logistic regression model adjusted by age showed that a tumor volume of > 7.5 cm 3 (odds ratio [OR]: 22.9; 95% confidence interval [CI]: 3.8-135.9, p = 0.001) and DM (OR: 8.9; 95% CI: 1.7-46.5; p = 0.010) are strong independent risk factors of Po-CSF leak in pure endoscopic endonasal pituitary surgery. Conclusion Besides younger age and DM, a cutoff value for tumor volume > 7.5 cm 3 is the most remarkable risk factor for Po-CSF leak in pure endoscopic pituitary surgery. These patients should carefully be assessed preoperatively and potential preemptive surgical strategies should be taken into consideration to avoid complications.

SELEÇÃO DE REFERÊNCIAS
Detalhe da pesquisa