We aimed to determine in which cases this procedure may be more effective based on the data of patients who underwent decompressive hemicraniectomy (DHC). Overall, 47 patients who underwent DHC due to acute middle cerebral artery (MCA) infarction between January 2014 and january 2019 were retrospectively investigated. These patients were divided into two groups: those who died after DHC (Group A) and those who survived DHC (Group B). The groups were compared in terms of various parameters. We investigated whether the patient’s modified Rankin scale (mRS) status changed depending on age (> 60 and < 60 years). The median age of all patients was 65 (37–80) years; groups A and B had median ages of 66.5 (37–80) and 61 (44–79) years (p = 0.111), respectively; 55.3% patients were male. The elapsed times until hospitalization after the onset of symptoms were 4.5 and 3 h in groups A and B, respectively (p = 0.014). The median GCS score at the time of admission was 7 (5–12) and 10 (8–14) in groups A and B, respectively (p = 0.0001). At the time of admission, 63.3% patients in group A had anisocoria, whereas no patient in group B had anisocoria (p = 0.0001). In postoperative period, 40% patients in group A and all patients in group B received AC/AA treatment. The survival of patients aged < 60 and > 60 years who underwent DHC for MCA infraction was 61.5% and 26.5%, respectively (p = 0,041). The median mRS of patients < 60 and > 60 years were 4 (1–6) and 6 (1–6), respectively (p = 0.018). Age, DHC timing, and elapsed time until hospitalization or access to treatment directly affect the functional outcome and survival in MCA-infarcted patients who underwent DHC. In patients in whom the medical treatment fails, early DHC administration will increase survival without waiting for neurological worsening once herniation is detected radiologically.

65 yaşındaki bir kadın hastada, bel ve bacak ağrısı şikayetleriyle yapılan incelemeler sonucunda L3 omurunda Hurthle hücreli tiroid karsinomu metastazı tespit edilmiştir. Tedavi sürecinde önce total tiroidektomi uygulanmış, ardından kanama riskini azaltmak için kitleyi besleyen damarlar embolize edilerek cerrahi rezeksiyon ve stabilizasyon işlemleri gerçekleştirilmiştir. Operasyon sonrası nörolojik defisiti kalmayan ve genel durumu düzelen hasta, radyoaktif iyot tedavisi ile takibe alınmıştır. A 65-year-old female patient presenting with back and leg pain was diagnosed with a Hurthle cell thyroid carcinoma metastasis in the L3 vertebra. Following a total thyroidectomy, the metastatic lesion was treated with arterial embolization to minimize bleeding risk, followed by surgical resection and spinal stabilization. The patient, who showed no neurological deficits postoperatively, was discharged in good condition and referred for radioactive iodine therapy.

Tiroid papiller karsinom tanısı alan 10 yaşındaki bir çocuk hastada, radyoterapiye yanıt vermeyen L3 vertebra metastazı saptanmıştır. Hastanın genç yaşı, uzun yaşam beklentisi ve lezyonun tek odakta olması nedeniyle cerrahi müdahale planlanarak retroperitoneal yaklaşımla L3 korpektomi ve anterior enstrümantasyon uygulanmıştır. Ameliyat sonrası dönemde nörolojik defisiti olmayan ve genel durumu iyi seyreden hasta, takiplerinin dördüncü ayında şikayetsiz bir şekilde izlenmeye devam etmektedir. Bu vaka, radyasyona dirençli spinal metastazlarda tam rezeksiyonun fonksiyonel iyileşme ve sağkalım üzerindeki kritik önemini vurgulamaktadır. A 10-year-old girl diagnosed with papillary thyroid carcinoma presented with a single L3 vertebral metastasis that remained unresponsive to radiotherapy. Given her young age, high life expectancy, and the solitary nature of the lesion, an L3 corpectomy and anterior instrumentation were performed via a retroperitoneal approach. The patient, who showed no neurological deficits postoperatively, remains symptom-free at her four-month follow-up while continuing treatment. This case highlights the importance of complete surgical resection for functional recovery and survival in patients with radiation-resistant spinal metastases.