Red Cell Distribution Width as a Predictor of Outcome in Cyanotic Congenital Cardiac Surgery

Background: Red blood cell distribution width (RDW) is a vital marker associated with various clinical states. In the present study, we aimed to determine the associations between RDW changes and adverse effects caused by pediatric cardiac surgery. Materials and Methods: In the present research, we retrospectively analyzed 100 pediatric patients enrolled in this study who were candidates for cardiac surgery. RDW was determined pre-and postoperatively and at the time of discharge from the hospital. Intubation time, duration of intensive care unit (ICU) stay and hospital stay, cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, vasoactive inotropic score (VIS), and mortality rate were determined as well. Results: Intubation time, duration of hospital stay, CPB time, ACC time, VIS, and mortality rate were significantly higher in the patients with higher RDW rates. Conclusion: This study demonstrated that RDW could be used as an essential indicator in predicting both morbidity and mortality caused by pediatric congenital heart surgery

Evaluation of infection in nylon and staple sutured wounds in surgeries of intertrochantericfemoral fractures

Infection of surgical wounds is an important complication and delays recovery and  the length of hospital stay. This study was aimed to determine the rate of infection in proximal femoral fracture surgeries in two methods of closure with nylon thread and stapl

Cranioplasty in Depressed Skull Fractures: A Narrative Review of the Literature

Background: Decompressive craniectomy (DC) is performed routinely following traumatic brain injury (TBI), including depressed fracture (DSF), and following other mass-occupying conditions such as large ischemic strokes. DC could be followed by cranioplasty (CP), which is associated with cosmetic and protective benefits. The appropriate choice of implant, ideal timing, complications, and avoiding reoperation are challenges that neurosurgeons face in CP. Objective: Our goal is to delineate validatable guidelines for physicians to make decisions based on the latest data in the literature. Results: CP is not just a cosmetic procedure but also a therapeutic option for patients with depressed fractures. Patients with decompressive craniectomies secondary to other conditions can also develop decompressive craniectomy syndrome needing CP. The choice of materials used for reconstruction is critical to ensure safety and effectiveness. Different alloplastic grafts, such as polymethyl methacrylate, hydroxyapatite, dynamic titanium mesh, and complex mesh patterns, are used in CP, and the advantages and disadvantages must be considered prior to the surgery. Complications are divided into intra- and post-operative groups, and understanding these complications enables the surgeon to diminish the chances of occurrence and enhance surgical consequences. The proper timing of CP following decompressive craniectomy remains controversial. Conclusion: CP is a simple and useful neurosurgical intervention in those with skull defects. CP provides protective and cosmetic benefits. The main objective of the surgical intervention is to restore the skull to its original shape, protect the brain from further injury and avoid decompressive craniectomy syndrome

Vertical triband flag sign for differential diagnosis of Rathke's cleft cyst

Background: The Rathke cleft cyst (RCC) is a type of cystic growth that is benign, circular, and well-defined with an incidence rate of 4 %. This study aims to identify a useful diagnostic imaging sign that can aid in the differentiation of RCC from other cystic lesions. Methods: We retrospectively analyzed the records of 42 symptomatic RCC patients who were referred to our facility between 2016 and 2023. The data for the study were obtained from our electronic database. All magnetic resonance imaging (MRI) studies were performed using a 1.5-T superconducting magnetic scanner. All patients underwent endonasal transsphenoidal surgical resection. All MRIs were reviewed and evaluated by a neurosurgeon and a neuroradiologist. Results: There were 8 (19 %) males and 34 (81 %) females with a mean age of 37.2-years. Our study identified a distinct imaging characteristic in 38 of the cases, which we have named the “vertical triband flag sign”, due to the growth of the cyst developing a specific appearance. The flag sign was mostly observed only in the T1-images (71.5 %), while in four cases the sign was spotted only in T2-images, and in four cases it appeared in both T1 and T2. In 4 cases, the flag sign was not observed in which further investigations revealed that these cases were suprasellar or small sellar RCCs. The dot sign, which is a characteristic finding in RCCs was only observed in one of our cases. Conclusion: Early diagnosis of RCCs may be facilitated by utilizing the vertical triband flag sign

Position-dependent hemodynamic changes in neurosurgery patients: A narrative review

Patient positioning is one of the milestones of neurological surgery, which significantly affects the surgical outcome and requires a multidisciplinary approach. Several positions are applied in neurosurgical interventions, including supine, lateral, park bench, prone, sitting, and semi-sitting. In this regard, different positions could lead to changes in intracranial pressure (ICP) and cerebral hemodynamics. Cerebral autoregulation (CA) is a safeguard for adequate cerebral perfusion that keeps cerebral blood flow (CBF) constant in a variable range of cerebral perfusion pressures (CPP). The clinical management of the dysfunction in CBF is still challenging due to the narrow range of cerebral self-regulation, especially in neurovascular and oncological neurosurgery. Moreover, patient positioning might predispose the patient to various intra- or postoperative complications. Changes in hemodynamics and cardiovascular function as a result of patient positioning have also been reported previously. The ICP monitoring aids us in managing surgical conditions and preventing sudden complications in neurosurgery, such as venous air embolism (VAE), hypotension, and arrhythmias. Other positional-related complications in neurosurgery are cerebral bleeding, venous and paradoxical air embolism, and pneumocephalus. Therefore, the present review aims to discuss different aspects of patient positioning in neurosurgical procedures, such as its potential impacts on cerebral hemodynamics and surgical outcomes