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BACKGROUND: Supratentorial midline epidural hematoma is rare but challenging in diagnosis and management. Indication for surgery can arise even following hospital admission. Being familiar to the presentation and watching out for direct and indirect signs on axial computed tomography (CT) such as suture diastasis or fracture traversing midline are essential to plan multi-planar CT enabling exact diagnosis including form and mass effect of hematoma. METHODS: Nine patients with midline epidural hematoma including two pediatric patients underwent surgery between 2013 and 2018. Pre-operative and post-operative patient status, radiological features, and surgical technique were analyzed. RESULTS: Four patients had deteriorating consciousness levels and two patients had paraparesis. All had fractures traversing midline and epidural hematomas with significant mass effect. They were operated through separated craniotomies around the midline and midline bone strip was used for dural tenting and as support for natural closure of bone flaps. No post-operative complications were developed. All patients were discharged with Glasgow Outcome Score of 5. CONCLUSION: Because of the rarity of the lesion and small number of patients, definitive conclusions may be misleading but we think that, in experienced hands, midline epidural hematomas can safely be operated on and, preservation of midline bone strip pro-vides easier bleeding control.

1970’li yillar ekonomide onemli degisimlere sahne olmustur. Kar oranlarinda ve verimlilikte dusus olarak kendini gosteren ekonomik kriz Fordist uretim duzeninin sorgulanmasina yol acmistir. Fordist katiliklarin ortadan kaldirilarak esneklestirme yonunde donusumler krizden cikmanin recetesi olarak gorulmustur. Fordist katiliklarin nedeni olarak gorulen sendikalarin gucu kirilmis, ucret ve calisma kosullari esneklesmeye baslamis, Fordist uretim paradigmasi yerini Post-Fordist uretim paradigmasina birakmistir. Ekonomik alt yapida meydana gelen post-Fordist donusum siyasi ust yapilari da etkileyerek kamu yonetimini donusturmustur. Fordist kamu yonetiminin hiyararsik yapisi ve kadrolu istihdam rejimi buyuk degisimler gecirmistir. Taseron, gecici ve sozlesmeli personel gibi istihdam bicimleri kamu istihdam rejiminde guclenmeye baslamis, zaman icinde kadrolu ve guvenceli istihdamin ortadan kalkacagi bir surece girilmistir. Kamu kurumlarinin calisma duzeni Post-Fordizm’den etkilenerek yatay ve esnek is iliskileri guclenmeye baslarken yoneticilik ve liderlik gibi kavramlar kamu sektorunun icerisine girmistir. Post-Fordist donemde, yerellesme ve ozellestirme egilimleri yeni uretim duzeninin gereksinimleri dogrultusunda guclenmekte, buna paralel olarak kamu hizmetleri de ozellestirme ve yerellesme yonunde ilerlemektedir. Devletin uretici rolunun duzenleyici olarak gelistigi Post-Fordist donusum, devleti yonetisim mekanizmasina uygun bir sekilde tasarlamakta, uretimin talep yonunden uzaklastirarak sosyal devleti bitirmekte, arz yonlu sorunlarla ilgilenen, rekabeti ve yenilikci kapasiteyi gelistiren bir devlet modeli ortaya cikarmaktadir. Bu yeni devlet modelinin ulus-devletten uzaklastigi, ulusal kalkinmanin sona erdigi seklinde yorumlar yapilmaktadir. Bu tezde Post-Fordist donemin genel olarak kamu yonetimi ve ozellikle de kamu personel rejiminde ortaya cikardigi donusum ve sonuclar analiz edilmistir.

Hydrothorax of the cerebrospinal fluid after a subarachnoid-pleural fistula is a rare condition. Subarachnoid-pleural fistula may appear after a trauma at the thoracolumbar vertebral column or iatrogenically after thoracotomy. A two years and four months old boy who was operated because of ganglioneuroblastoma was admitted to hospital due to respiratory distress. The chest roentgenogram obtained two months after thoracotomy, showed a pleural effusion at the left side and a chest tube was inserted. The craniospinal magnetic resonance imagining revealed subarachnoid-pleural fistula and lumbar external cerebrospinal fluid drainage was performed. The chest tube was removed by application of tetracycline between pleural layers. After the patient was discharged, respiratory distress reoccured after 3 weeks and a chest tube was reinserted due to fluid at the left hemithorax. An external lumbar drainage was reapplied. The location of the fistula was determined by craniospinal magnetic resonance imagining and myelography. The fistula was surgically restored by a posterior approach and laminectomy. The cerebrospinal fluid drainage and chest tube was removed three days and seven days after the operation respectively. The patient was discharged at the 13 days after the operation. During periodical outpatient follow up the patient has no symptoms and is neurologically intact. Subarachnoid-pleural fistulas, usually do not regress spontaneously or respond to conservative methods. Invasive approaches including surgery may be needed to treat patients with subarachnoid-pleural fistulae.