The clinical features, perioperative course, and postoperative outcomes of 144 patients who underwent microsurgical resection of craniopharyngioma were reviewed. Overall, 90% of the tumors were completely resected and 7% recurred. Evaluation of those patients who underwent primary resection revealed much better results. The operative techniques and approaches are reviewed in detail. The results of this series suggest that primary total removal of craniopharyngiomas yields the best long-term outcome for the patient. Experience has shown that the larger the tumor the greater will be the damage, both preoperatively and intraoperatively, to vital intracranial structures. Consequently, early diagnosis, at a stage when the tumor is still small, improves the chances of accomplishing complete removal and of achieving good operative results. The early diagnosis of craniopharyngioma, before it can produce devastating neurological defects, continues to be the principal goal of our medical and pediatric colleagues.

Osteopoikiosis is a rare condition showing characteristic sclerotic lesions on radiographic examination, which are diagnostic for the frait. We report four patients presenting with various complaints and 49 members of their families who later were found to have osteopoikilosis. The mean age of all 53 was 27.5 years and the male:female ratio was 33:20. Most had lesions in the small tubular bones. We studied the epidemiological, clinical and radiological features ofthese patients and from the pedigrees conclude that the disease is inherited as an autosomal dominant.

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The basic principles of current idiopathic scoliosis treatment are three-dimensional correction and rigid fixation. Although it is accepted that Cotrel-Dubousset instrumentation (CDI) meets these goals, there is concern about the potential risk of trunk imbalance and spinal decompensation during the derotation manoeuvre. The results of 45 patients with idiopathic scoliosis treated with CDI between December 1988 and August 1992 were retrospectively analysed. Mean age was 14.3 years and mean follow-up period was 48.6 months. An average correction of 49.6% was achieved in the major curves. The best results were obtained in King type III curves, with a 69.4% correction. Spinal imbalance was evaluated by measuring lateral trunk shift (LT), shift of head (SH) and shift of stable vertebra (SS). Decompensation was measured by the increase in secondary curves. When all curve types were included, the average preoperative LT value of 1.96 vertebral units (VU) was brought down to 0.91 VU postoperatively, achieving a 55.9% correction. Fourteen patients had an SH value of zero preoperatively and remained balanced after instrumentation. Of the 41 remaining patients, 21 achieved an SH value of zero postoperatively. When all cases were included, the average preoperative SH value was 1.0 VU, which was corrected to 0.42 VU with CDI (69% correction). An average correction of SS of 75.5% was obtained, with the mean preoperative value of 0.73 VU being corrected to 0.19 VU. At the last follow-up visit, a secondary curve had formed above the major curve in one patient, and three patients had a junctional kyphosis. Loss of correction in the frontal plane correlated with loss of correction of LT. The rigid and semiflexible lumbar curves had a tendency to progress when they were not instrumented, especially in type II curves. Junctional kyphosis could be prevented when concave laminar claws were used in the thoraco-lumbar region. It was concluded that spinal decompensation and imbalance could be minimized with careful preoperative planning, avoidance of overcorrection and use of long instrumentation in double major curves.

BACKGROUND: The goal of this retrospective study was to clarify the effect of using temporary vascular shunt (TVS) as a previous intervention. METHODS: A total of 96 cases with war-related lower extremity arterial injury and surgically treated between October 2013 and March 2016 were included in the study. The patients were divided into two groups: those in which TVS was performed as a previous intervention on admission (TVS group, n=24) and those in which compression, tourniquet, and ligation/clampage were performed as a previous intervention on admission (non-TVS group, n=72). RESULTS: In comparing injury pattern, there was no difference between the two groups. In addition, mean hematocrit level, mean systolic blood pressure, the incidence of concomitant vein injury, nerve injury, soft tissue damage, and bone injury were similar in both groups. The overall amputation rate was 19%. There were a total of 18 amputations, with 1 (4%) in the TVS group and 17 (24%) in the non-TVS group. The difference on amputation rate was statistically significant. The mean values of the mangled extremity severity score (MESS) were 6.45 in the TVS group and 7.44 in the non-TVS group. The overall mean MESS was 7.1. The duration of ischemia (DoI) was 4.84±1.84 h in the TVS group and 5.95±1.92 h in the non-TVS group. These differences in MESS and DoI were statistically significant. CONCLUSION: We think that it may be beneficial for patients to consider a TVS to reduce DoI and gain time for surgical revascularization. As a result, the present study demonstrates that the use of TVS may successfully serve as a bridge between initial injury and definitive repair with a reduction in amputation rates.