This study aimed to report the authors' single-center clinical experience about craniopharyngiomas and discuss surgical outcomes of these patients according to the type of surgical approach (endoscopic endonasal or open microscopic transcranial approach).Twenty-four patients diagnosed with craniopharyngiomas between May 2013 and April 2017 were considered for inclusion. The patients were divided into 2 groups according to the surgical approach (open transcranial microscopic approach [group A] and endoscopic endonasal approach [group B]). These groups were compared in terms of postoperative surgical outcome scores (extent of tumor removal, visual deficit, hydrocephalus, metabolic disorders, and Glasgow coma scale) and hospitalization interval.There was no patient of mortality in both groups. In this study, 4 of the 13 patients in group A and 9 of the 11 patients in group B underwent gross total resection. However, 1 patient in group B underwent repair because of cerebrospinal fluid leakage postoperatively. In addition, 1 patient in group A had a wound healing problem postoperatively. The postoperative outcome scores were 9.5 in group A and 11.5 in group B. The hospitalization interval in group A (range, 7-9 days) was longer than that in group B (range, 5-7 days).The endoscopic endonasal approach should be considered the first-line surgical treatment modality in patients with a preliminary diagnosis of craniopharyngioma in terms of low complication risk, minimal invasiveness, and better outcome scores. Open microscopic transcranial procedures may be combined with this approach in a single session for challenging cases.
We outline the key for management of a rare intracranial air entrapment case after an endoscopic odontoidectomy surgery in a pediatric patient and the measures taken to prevent its occurrence in the future.
Öz DRESS Sendromu ateş, cilt döküntüsü, iç organ tutulumu ve hematolojik anormalliklerle karakterize akut başlangıçlı, hayatı tehdit eden, nadir görülen, ilaca bağlı bir aşırı duyarlılık reaksiyonudur. En sık nedeni aromatik antikonvülzan kullanma sonrası görülmektedir. Bu olguda fenitoin kullanımı sonrasında ikinci haftada ateş yüksekliği ve cilt döküntüleri başlayan kırk dört yaşında bir erkek hasta sunulmuştur. Olgu, fenitoin tedavisinin kesilmesi sonrasında sistemik kortikosteroid ve destek tedavisi ile başarılı bir şekilde tedavi edilebilmiştir. Birinci basamakta aile hekimi, hastalarının akut ve kronik sağlık sorunlarını aynı anda yönetebilmelidir. Olgumuzda olduğu gibi akut başlangıçlı ateşe yaklaşımda bir aile hekimi hastasını iyi yönetebilmeli ve beraberinde cilt döküntüleri de gördüğünde kullandığı ilaçları da sorgulayarak DRESS Sendromunu akla getirmelidir. Anahtar Kelimeler: DRESS sendromu, fenitoin, cilt döküntüsü Abstract DRESS syndrome is a life threatening, rare hypersensitivity reaction to drugs with an acute onset that is characterized by fever, skin rash, visceral involvement, and hematological abnormalities. It is often seen after the use of aromatic anticonvulsants. In this article, a forty-four year old male patient with fever and skin rash after two weeks of phenytoin administration is discussed. He has been treated successfully with systemic corticosteroids and supportive therapy after the discontinuation of phenytoin therapy. In first step health-care, the primary physician should be able to administer his patients' acute and chronic health problems concurrently. As in our case, a family physician should administer his patient well in the presence of fever with acute onset and he should question about the drugs used in the presence of accompanying skin rash.
Background The objective of the present study is to analyze the outcomes of patients with subarachnoid hemorrhage (SAH) in the acute phase after treatment with Y-stent-assisted coiling (YSAC) embolization. Methods This retrospective study assessed of 30 patients with acutely ruptured wide-neck aneurysms following YSAC treatment between April 2013 and October 2019. The demographic data, aneurysm occlusion grade, procedural and periprocedural complications, and clinical outcomes were assessed. Results The procedure was completed in 30 cases (90.1%) and technical failure occurred in 3 cases (9.1%). Immediate control angiography revealed that total occlusion Raymond-Ray Class 1 (RR1) was achieved in 21 (70%), neck filling (RR2) in eight (26.6%) and sac filling (RR1) in one (3.3%) aneurysm. Upon angiographic follow-up, RR1 occlusion was observed in 15 (71.4%) patients, RR2 in three (14.3%) patients and RR3 in three (14.3%) patients. In-stent thrombus developed in five (16.6%) patients; procedural ischemic events were observed in four (13.3%) patients; and two (6.6%) patients were symptomatic. A periprocedural asymptomatic intracranial hemorrhage was detected in two patients. At discharge, 17 (56.6%) patients were in good clinical condition, six (20%) were in a severe disability condition, and seven (23.3%) patients had died. At the final follow-up visit (mean: 18.9 months), 16 (76,2%) of 21 patients were in a good clinical condition and five (23.8%) had severe disabilities. Conclusions Y-stent assisted coiling in might be a feasible and promising option for treatment in acute phase in selected wide-necked ruptured intracranial aneurysms.
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