A 33-year-old male presented with intracerebral hemorrhage in the left temporoparietal region after a traffic accident. Ten months later, the traumatic hemorrhage was found to originate in an underlying giant cell glioblastoma. Our case indicates that non-traumatic underlying pathologies, such as vasculopathies, coagulopathies, or tumors, should be considered in the differential diagnoses of intracerebral hemorrhage occurring in unusual locations after traumatic accidents.

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Objective: Craniopharyngiomas are one of the most challenging problems for neurosurgeons because of the high recurrence rates due to their localization and associated endocrinological disorders. This study reports the outcomes of surgeries and recurrence rates of 45 craniopharyngioma cases. Method: Patients who were diagnosed with craniopharyngioma in the authors’ clinic between 1998 and 2016 evaluated retrospectively. Results: A total of 45 patients (25 males and 20 females; age, 3–56 years) who had previously undergone surgery for craniopharyngioma were enrolled and followed up for 12 to 222 months (mean follow-up duration, 73.5 ± 55.2 months). Among these, 25 were children (55.5%) with a mean age of 9.5 ± 4.6 years and 20 were adults (45.5%) with a mean age of 37.2 ± 12.7 years. A total of 39 (86.6%) patients underwent total tumor resection, while 6 (13.4%) underwent subtotal tumor removal. During 12 to 30 months of follow-up, the progression of residual tumor was recorded in 4 patients, 3 of whom underwent surgery and postoperative radiotherapy. Despite the total resection of tumor in their first surgery, 3 patients showed tumor recurrence during 15 to 34 months of the follow-up. Conclusion: Our findings suggest that the total resection of craniopharyngiomas, when possible, results in a favorable quality of life, with acceptable mortality and morbidity rates.

mass should not be taken in consideration, especially in the diagnosis of deeply located, diffused infiltrative or multiple space-occupying lesions, computerized tomography (CT) or MRI-guided stereotactic biopsies have been proven to be safe and reliable by various studies (2,4,(7)(8)(9)(11)(12)(13)15,16,18,19,(21)(22)(23)(25)(26)(27)(28)(29)(31)(32)(33)(34)(35)(36)(37)(38) Despite the tremendous improvement in neuroradiology and nuclear medicine, especially in magnetic resonance imaging (MRI) and positron emission tomography (PET), definitive diagnosis in most brain lesions require histopathological examination. When a bulk excision of the AIm: Computed tomography (CT)-guided stereotactic brain biopsy has been performed in our clinic since March 1998. In this prospective study, we examined the patient data undergoing stereotactic biopsy and the results of biopsies in 500 consecutive patients. mATERIAl and mEThODS: Between the dates of March 1998 and January 2015, CT-guided stereotactic biopsies were performed by using the Leksell stereotactic frame system (Elekta Instruments EU, Sweden) in 500 patients. A total of 512 procedures were performed in patients consisting of 184 females (36.8%) and 316 males (63.2%), ages ranging from 3 to 81 years (mean 50.40±16.67). RESUlTS:Conclusive histopathological diagnosis was not achieved in 17(3.3%) of 512 procedures. Of the others, 173 (33.8%) were high-grade gliomas, 103 (20.1%) were low-grade gliomas, 36 (7%) were malignant lymphomas, 34 (6.6%) were other types of brain tumors, 82 (16%) were metastasis and 67 (13.1%) were non-tumoral lesions. Complications were occurred in ten cases: 3 tumoral bleedings, 2 hypertensive cerebral hematomas, 2 peroperative convulsions, 1 epidural hematoma, 1 myocardial infarction and 1 brain edema. The patients who developed myocardial infarction and hypertensive thalamic hematoma died. The mortality was 0.4% and morbidity was 1.6% in 512 procedures.CONClUSION: CT-guided stereotactic biopsy is a reliable and a safe procedure in cases with intracranial lesions when histopathological diagnosis is required for the appropriate treatment.

D esmoplastik infantil astrositomlar (DİA), nadir, genellikle infantlarda görülen, çoğunlukla benign, DSÖ grade 1 tümörlerdir. Radyolojik olarak agresif görünümlü olmalarına rağmen, subtotal eksizyonlardan sonra bile iyi prognozlu olup, benign gidiş gösterirler. [1] Subpial astrositlerden kaynaklandıkları düşünülmektedir. [1,2] İnfantlarda genellikle ilk 2 yaşta, en sık 3-6 aylarda kafa çapında artış, nöbet geçirme, parezi belirtileri ile ortaya çıkarlar. Frontal lob başta olmak üzere parietal ve temporal loblarda yerleşirler. Ventriküle bası yapabilir, solid-kistik komponent içe-rirler. Çoğu vakada tümörün tam veya tama yakın cerrahi çıkarımı tedavi için yeterlidir. [1,2] Bu yazıda oldukça nadir görülen tümör olan 2 DİA olgusu sunuldu. Olgu SunumuOlgu 1 -Sağ kol ve sağ bacakta kasılma şikayetleri ile başvuran 1 yaşındaki kız hastada yapılan ilk nörolojik muayenede nörolojik defisit saptanmadı. Klinik olarak basit parsiyel nöbet olarak değerlendirilen olguda kranial manyetik Desmoplastik İnfantil Astrositomlar (DİA), sıklıkla hayatın ilk 24 ayında görülen, nadir görülen supratentoriyal tümörlerdir. Agresif görünümlerine rağmen iyi prognozludurlar. Total veya totale yakın rezeksiyon genellikle yeterli tedavidir. Desmoplastik İnfantil Ganglioglioma (DİG) ve DİA benzer klinik ve morfolojik bulgular gösteren DSÖ (Dünya Sağlık Örgütü) Grade 1 tümörlerdir. DİA'nın nöral komponent içermemesi DİG ile ayırıcı tanısında tek kriterdir. İnfantil olmayan vakalar bildirilmiş olmasına rağmen, genellikle erken çocukluk döneminde görülürler. Bu olguların stromaları yoğun fibroblastik olup immunohistokimyasal olarak GFAP ve CD34 pozitiflikleri gösterirler. Çalışmada her ikisi de 1 yaşında olan, biri kız diğeri erkek olan 2 olgu literatür bilgileri eşliğinde sunuldu. 1 yaşındaki hastada sağ tarafta parsiyel motor nöbetle presente olan, parietofrontal lokalizasyonlu nadir görülen desmoplastik infantil astrositom olgusu sunuldu. 1 yaşındaki hastada fokal başlangıçlı generalize motor nöbetle ortaya çıkan temporal lokalizasyonlu DİA olgusu sunuldu. Bu olgular radyolojik ve histolojik özelliklerine rağmen iyi gidişli benign seyirli tümörlerdir. Birinci olgumuzun 3 yıllık, 2. olgunun bir yıllık takiplerinde nüks izlenmedi. Anahtar sözcükler: Desmoplastik infantil astrositom; iyi klinik seyir; supratentoriyal.

If patients are carefully selected and individually assigned to their optimum treatment modality, IUAs can be obliterated by surgery with a low percentage of unfavorable outcomes.

Greater prevalence of ACs in patients with CSDHs has been reported in the literature. We recommend the drainage of the hematoma via a single craniostomy and to leave the AC intact as the first choice of treatment if the associated AC is a Galassi type I or II. Additional subduroperitoneal shunting may be performed in patients with Galassi type III cyst.

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