Browsing by Author "Ormeci, Mehmet Tolgahan"

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Early Surgical Intervention in Pediatric Trauma Patients With GCS 3 - Results of 8 Years Experience
(Elsevier, 2025) Boyraz, Merve; Yuce, Servet; Ozel, Abdulrahman; Ormeci, Mehmet Tolgahan; Ozen, Hasan; Akkaya, Sueleyman; Botan, Edin
Objectives: Traumatic brain injury (TBI) is the leading cause of death and disability in children. Mortality and morbidity increase dramatically in patients with severe brain injury and a Glasgow Coma Scale (GCS) score of 3. This study evaluates the impact of early surgery (within 0-6 h) on mortality and morbidity in this patient group, often considered "hopeless cases." Methods: Children with TBI and a GCS score of 3 admitted to the Pediatric Intensive Care Unit of Van Training and Research Hospital between 2016 and 2024 were retrospectively analyzed. Medical records, imaging studies, and outcomes were reviewed. Mortality and neurological sequelae were assessed within one year using the Glasgow Outcome Scale (GOS). Results: Among 514 children admitted with isolated head trauma, 11.3 % (n = 58) had a GCS score of 3. Twelve patients (20.7 %) died within the first 4 h due to hemodynamic instability and were excluded. Of the remaining 46 patients, 14 (30.4 %) underwent cranial surgery, while 32 (69.6 %) received medical treatment. Mortality rates were 50 % (7/14) in the surgical group and 71.8 % (23/32) in the medical group (p = 0.137). Neurological sequelae were significantly lower in the surgical group (14.3 % vs. 77.8 %, p = 0.020). Early surgery (within 6 h) resulted in lower mortality (25 % vs. 83.3 %, p = 0.005) and better neurological outcomes, with all survivors discharged neurologically intact. In contrast, the only survivor operated on after 6 h had neurological sequelae. Conclusion: Early decompressive craniectomy (within 6 h) significantly reduces mortality and neurological sequelae in pediatric patients with severe TBI (GCS: 3). These patients should not be dismissed as "hopeless" but given the opportunity for surgical intervention.
Identifying the Need for Surgical Intervention in Pediatric Bacterial Meningitis: Single-Center Experience
(Frontiers Media S.A., 2025) Boyraz, Merve; Yuce, Servet; Ozel, Abdulrahman; Ormeci, Mehmet Tolgahan; Akkaya, Suleyman; Koksal Atis, Seyma; Botan, Edin
Background: Intracranial complications of bacterial meningitis can arise at any stage and may necessitate neurosurgical intervention. This study evaluates clinical, laboratory, and imaging findings predictive of surgical need in these cases. Methods: Between 2013 and 2023, 52 pediatric patients with severe neurological symptoms due to bacterial meningitis were admitted to PICU at Van Training and Research Hospital. Patients were classified into two groups: those with intracranial complications (Group 1, n = 36) and those without (Group 2, n = 16). Group 1 was further divided into those requiring surgery (Group 1B, n = 9) and those not (Group 1A, n = 27). Statistical analyses were conducted. Results: Among 52 patients (67.3% male, mean age 76.7 +/- 72.0 months), 36 (69.2%) developed intracranial complications, and 9 (17.3%) required surgery. CRP levels were significantly higher in Group 1B (226 mg/dl) than in Group 1A (63 mg/dl) (p < 0.001). Significant differences were also found in CSF protein/glucose ratio (p = 0.011) and CSF glucose levels (p = 0.049). Subdural empyema (SDE) developed in 25 cases, with single-area involvement significantly more frequent in surgical cases (77.8% vs. 12.5%, p = 0.012). ROC analysis was performed for CSF protein/glucose, CSF glucose, and serum CRP values. Conclusion: CRP >150 mg/dl, CSF glucose <6.75 mg/dl, and protein/glucose ratio >18.9 indicate high surgical risk. MRI is recommended for localization, with early neurosurgical consultation and multidisciplinary management for cases with single-area empyema.