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Kronik Subdural Hematomlu Hastalarda Cerrahi Tedavi Sonuçlarımız: Yetmiş Altı Hastanın Analizi

Yıl 2018, Cilt: 71 Sayı: 3, 71 - 251, 25.12.2018

Vural Hamzaoglu

Öz

Amaç: Kronik subdural hematomlar (KSH) genellikle orta ve ileri yaşta görülen intrakraniyal kanamalardır. Serebral atrofi nedeniyle gerilen parasagital köprü venlerin kanaması sonucu görülmektedirler. Kliniğimizde KSH nedeniyle cerrahi olarak tedavi edilen hastaların sonuçları araştırılmıştır.

Gereç ve Yöntem: 2008-2016 yılları arasında Mersin Üniversitesi Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı’nda KSH tanısı alarak cerrahi yöntemle tedavi edilen 76 hasta çalışmaya dahil edilmiştir. Hastalar burr hole ile hematom drenaj ve kraniyotomi ile hematom drenajı olmak üzere iki gruba ayrılarak klinik sonuçlar açısından retrospektif olarak değerlendirilmiştir.

Bulgular: Hastaların 52’si erkek, 24’ü ise kadın ve ortalama yaş 64,8 olarak tespit edildi. Hastalarda görülen en sık başvuru şikayeti baş ağrısı olarak saptandı (%52,6). Yirmi sekiz hastada (%36,8) geçirilmiş bir kafa travması olduğu belirlendi. Antikoagülan ilaç kullanımı 18 hastada (%23,6) tespit edilirken, 38 hastada (%50) komorbiditeye neden olabilecek en az bir hastalık belirlendi. Hematomun en sık görüldüğü lokalizasyon ise 26 hastada (%34,2) sol frontoparietooksipital bölge olarak saptandı. Altmış beş olguda (%85,5) burr hole ile 11 olguda ise (%14,5) kraniyotomi ile hematom boşaltıldığı tespit edildi. Tüm hastalardaki ortalama hematom kalınlıkları 22,0 mm iken, ortalama orta hat şiftleri 6,8 mm olarak tespit edildi. Burr hole ile hematom drenajı yapılan hastalarda komplikasyon oranı %26,6 iken kraniyotomi ile opere edilen hastalarda bu oran %0,9 olarak belirlendi. Mortalite burr hole grubunda 3 olguda (%4,6) ve kraniyotomi grubunda ise 2 olguda (%18,1) saptandı.

Sonuç: İleri yaş grubunda oldukça sık görülen ve cerrahi tedavi yöntemleri geniş oranda morbidite ve mortaliteye yol açabilen KSH’de tedavisinde seçilecek cerrahi yöntem hala tartışmalıdır. Burr hole ile hematom drenajı daha yüksek komplikasyon oranları ile sonuçlanırken kraniyotomi uygulanan olgularda ise mortalite oldukça yüksek oranda tespit edilmiştir.

Anahtar Kelimeler

Kronik Subdural Hematom Burr Hole Kraniyotomi

Etik Beyan

Mersin Üniversitesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır. (Onay no: 2018/498)

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Kaynakça

  • 1. Fırati A, Salvati M, Mainiero F, et al. Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma: A prospective study. J Neurosurg. 2004;100:24-32.
  • 2. Okada Y, Akai T, Okamoto K, et al. A comparative study of the treatment of chronic subdural hematoma--burr hole drainage versus burr hole irrigation. Surg Neurol. 2002;57:405-9.
  • 3. Markwalder TM. Chronic Subdural Hematomas: a review. J Neurosurg. 1981;54:637-45.
  • 4. Çelikoğlu E, İş M, Yılmaz M, et al. Kronik Subdural Hematom Olgularımızın Cerrahi Sonuçları. Sinir Sistemi ve Cerrahi Derg. 2014;4:36-41.
  • 5. Su TM, Shih TY, Yen HL, et al. Contralateral acute subdural hematoma occurring after evacuation of subdural hygroma: Case report. J Trauma. 2001;50:557–559.
  • 6. Tatlı M, Güzel A, Altınörs N. Spontaneous Acute Subdural Hematoma following Contralateral Calcified Chronic Subdural Hematoma Surgery: An Unusual Case. Pediatr Neurosurg. 2006;42:122–124.
  • 7. Lee JY, Ebel H, Ernestus RI, et al. Various. Surgical treatments of chronic hematoma and outcome in 172 patients: İs membranectomy necessary?. Surg Neurol. 2004;61:523-528.
  • 8. Stanisic M, Lund-Johansen M, Mahesparan R. Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: İnfluence of some factors on postoperative recurrence. Acta Neurochir (Wien). 2005;147:1249-1256.
  • 9. Watts C. The Management of Intracranial calcified subdural hematomas. Surg.NeuroI. 1976;6:247-250.
  • 10. Ernestus RI, Beldzinski P, Lanfermann H, et al. Chronic subdural hematoma: Surgical treatment and outcome in 104 patients. Surg Neurol. 1997;48:220- 225.
  • 11. Sambasivan M. An overview of chronic subdural hematoma: Experience with 2300 cases. Surg Neurol 1997;47:418-422.
  • 12. Liliang PC, Tsai YD, Liang CL, et al. Chronic subdural haematoma in young and extremely aged adults: A comparative study of two age groups. Injury. 2002;33:345-348.
  • 13. Gelabert-González M, Iglesias-Pais M, García-Allut, et al. Chronic subdural haematoma: Surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg. 2005;107:223-229.
  • 14. Fogelholm R, Heiskanen O, Waltimo O. Chronic subdural haematomas in adults. Influence of patient’s age on symptoms, signs and thickness of haematoma. J Neurosurgery. 1975;42:43-46.
  • 15. Lind CR, Lind CJ, Mee EW. Reduction in the number of repeated operations for the treatment of subacute and chronic subdural haematomas. J Neurosurgery. 2003;99:44-6.
  • 16. Liliang PC, Tsai YD, Liang CL, et al. Chronic subdural haematoma in young and extremely aged adults: A comparative study of two age groups. Injury. 2002;33:345-348.
  • 17. Harada K, Ohtsuru K, Nakayama K, et al. Contralateral development of acute subdural hematoma following surgery for chronic subdural hematoma: Case report. Neurol Med Chir (Tokyo). 1992;32:969–971.
  • 18. Baechli H, Nordmann A, Bucher HC, et al. Demographics and prevalent risk factors of chronic subdural haematoma: Results of a large single-center cohort study. Neurosurg Rev. 2004;27:263-266.
  • 19. Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural haematomas that influence their postoperative recurrence. J Neurosurg. 2001;95:256-262.
  • 20. Turgut M, Akalan N, Saglam S. A fatal acute subdural hematoma occurring after evacuation of “contralateral” chronic subdural hematoma. J Neurosurg Sci. 1998;42:61–63.
  • 21. Torihashi K, Sadamasa N, Yoshida K, et al. Independent predictors for recurrence of chronic subdural hematoma: A review of 343 consecutive surgical cases. Neurosurgery. 2008;63:1125-1129.
  • 22. Mori K, Maeda M. Surgical treatment of chronic subdural haematoma in 500 consecutive cases: Clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med-Chir (Tokyo). 2001;41:371-381.
  • 23. Imaizumi S, Onuma T, Kameyama M, Naganuma H. Organized chronic subdural hematoma requiring craniotomy— five case reports. Neurol Med Chir (Tokyo). 2001;41:19–24
  • 24. Cenic A, Bhandari M, Reddy K. Management of chronic subdural hematoma: A national survey and literature review. Can J Neurol Sci. 2005;32:501–506.
  • 25. Rohde V, Graf G, Hassler W. Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: A retrospective analysis of 376 patients. Neurosurg Rev. 2001:25:89–94.
  • 26. HanH, ParkC, KimE, et al. Onevs. two burr hole craniostomy in surgical treatment of chronic subdural hematoma. J Korean Neurosurg Soc. 2009;46:87–92.
  • 27. Kansal R, Nadkarni T, Goel A. Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases. J Clin Neurosci. 2010;17:428–429
  • 28. Wakai S, Hashimoto K, Watanabe N, et al. Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective comparative study. Neurosurgery. 1990;26:771–773.
  • 29. Moon KS, Lee JK, Kim TS, et al. Contralateral acute subdural hematoma occurring after removal of calcified chronic subdural hematoma. J Clin Neurosci. 2007;14:283-286.
  • 30. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 2003; 74(7):937–43

Surgical Treatment Outcomes of Our Patients with Chronic Subdural Hematoma: A Review of Seventy Six Cases

Yıl 2018, Cilt: 71 Sayı: 3, 71 - 251, 25.12.2018

Vural Hamzaoglu

Öz

Objectives: Chronic subdural hematomas (CSH) are generally the intracranial hematomas seen in the middle and elder aged group. The hemorrhage is formed as a result of stretched parasagittal bridge veins due to cerebral atrophy. The patients’ outcome that underwent surgery because of CSH was investigated in our clinic.

Materials and Methods: Seventy-six operated CSH patients were included to the study in the University of Mersin, Faculty of Medicine between 2008 and 2016. The patients were divided into two groups with the drainage of burr-hole and craniotomy and evaluated in terms of clinical outcome retrospectively.

Results: There are 52 male, 24 female patients with the mean age of 64.8 detected in the group. The most common initial symptom at admission is headache (52.6%). The head trauma was reported in 28 (36.8%) patients. The use of anticoagulant drug in 18 patients (23.6%) and also at least one comorbid disease in 38 patients (50%) were detected among CSH. The most common localization for the hematoma was left fronto parietooccipital in 26 patients (34.2%). Burr-hole in 65 (85.5%) patients, craniotomy in 11 (14.5%) patients were performed for the evacuation of the CSH. The mean thickness of all the hematomas was detected as 22.0 mm and the mean midline shift was measured as 6.8 mm. The complication rate was 26.6% in the group with burr-hole whereas it was 0.9% in the group with craniotomy. The mortality was 4.6% (3 cases) in the burr-hole group, 18.1% (2 cases) in the craniotomy group.

Conclusion: The choice of surgical treatment modality was still controversy in the management of CSH that leads to morbidity and mortality which is most commonly seen in elder patient group. While the complication rate was being resulted as high in the group evacuated with burr-hole, the mortality was particularly high in the group with craniotomy.

Anahtar Kelimeler

Chronic Subdural Hematoma Burr-Hole Craniotomy

Etik Beyan

Mersin Üniversitesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır. (Onay no: 2018/498)

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Kaynakça

  • 1. Fırati A, Salvati M, Mainiero F, et al. Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma: A prospective study. J Neurosurg. 2004;100:24-32.
  • 2. Okada Y, Akai T, Okamoto K, et al. A comparative study of the treatment of chronic subdural hematoma--burr hole drainage versus burr hole irrigation. Surg Neurol. 2002;57:405-9.
  • 3. Markwalder TM. Chronic Subdural Hematomas: a review. J Neurosurg. 1981;54:637-45.
  • 4. Çelikoğlu E, İş M, Yılmaz M, et al. Kronik Subdural Hematom Olgularımızın Cerrahi Sonuçları. Sinir Sistemi ve Cerrahi Derg. 2014;4:36-41.
  • 5. Su TM, Shih TY, Yen HL, et al. Contralateral acute subdural hematoma occurring after evacuation of subdural hygroma: Case report. J Trauma. 2001;50:557–559.
  • 6. Tatlı M, Güzel A, Altınörs N. Spontaneous Acute Subdural Hematoma following Contralateral Calcified Chronic Subdural Hematoma Surgery: An Unusual Case. Pediatr Neurosurg. 2006;42:122–124.
  • 7. Lee JY, Ebel H, Ernestus RI, et al. Various. Surgical treatments of chronic hematoma and outcome in 172 patients: İs membranectomy necessary?. Surg Neurol. 2004;61:523-528.
  • 8. Stanisic M, Lund-Johansen M, Mahesparan R. Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: İnfluence of some factors on postoperative recurrence. Acta Neurochir (Wien). 2005;147:1249-1256.
  • 9. Watts C. The Management of Intracranial calcified subdural hematomas. Surg.NeuroI. 1976;6:247-250.
  • 10. Ernestus RI, Beldzinski P, Lanfermann H, et al. Chronic subdural hematoma: Surgical treatment and outcome in 104 patients. Surg Neurol. 1997;48:220- 225.
  • 11. Sambasivan M. An overview of chronic subdural hematoma: Experience with 2300 cases. Surg Neurol 1997;47:418-422.
  • 12. Liliang PC, Tsai YD, Liang CL, et al. Chronic subdural haematoma in young and extremely aged adults: A comparative study of two age groups. Injury. 2002;33:345-348.
  • 13. Gelabert-González M, Iglesias-Pais M, García-Allut, et al. Chronic subdural haematoma: Surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg. 2005;107:223-229.
  • 14. Fogelholm R, Heiskanen O, Waltimo O. Chronic subdural haematomas in adults. Influence of patient’s age on symptoms, signs and thickness of haematoma. J Neurosurgery. 1975;42:43-46.
  • 15. Lind CR, Lind CJ, Mee EW. Reduction in the number of repeated operations for the treatment of subacute and chronic subdural haematomas. J Neurosurgery. 2003;99:44-6.
  • 16. Liliang PC, Tsai YD, Liang CL, et al. Chronic subdural haematoma in young and extremely aged adults: A comparative study of two age groups. Injury. 2002;33:345-348.
  • 17. Harada K, Ohtsuru K, Nakayama K, et al. Contralateral development of acute subdural hematoma following surgery for chronic subdural hematoma: Case report. Neurol Med Chir (Tokyo). 1992;32:969–971.
  • 18. Baechli H, Nordmann A, Bucher HC, et al. Demographics and prevalent risk factors of chronic subdural haematoma: Results of a large single-center cohort study. Neurosurg Rev. 2004;27:263-266.
  • 19. Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural haematomas that influence their postoperative recurrence. J Neurosurg. 2001;95:256-262.
  • 20. Turgut M, Akalan N, Saglam S. A fatal acute subdural hematoma occurring after evacuation of “contralateral” chronic subdural hematoma. J Neurosurg Sci. 1998;42:61–63.
  • 21. Torihashi K, Sadamasa N, Yoshida K, et al. Independent predictors for recurrence of chronic subdural hematoma: A review of 343 consecutive surgical cases. Neurosurgery. 2008;63:1125-1129.
  • 22. Mori K, Maeda M. Surgical treatment of chronic subdural haematoma in 500 consecutive cases: Clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med-Chir (Tokyo). 2001;41:371-381.
  • 23. Imaizumi S, Onuma T, Kameyama M, Naganuma H. Organized chronic subdural hematoma requiring craniotomy— five case reports. Neurol Med Chir (Tokyo). 2001;41:19–24
  • 24. Cenic A, Bhandari M, Reddy K. Management of chronic subdural hematoma: A national survey and literature review. Can J Neurol Sci. 2005;32:501–506.
  • 25. Rohde V, Graf G, Hassler W. Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: A retrospective analysis of 376 patients. Neurosurg Rev. 2001:25:89–94.
  • 26. HanH, ParkC, KimE, et al. Onevs. two burr hole craniostomy in surgical treatment of chronic subdural hematoma. J Korean Neurosurg Soc. 2009;46:87–92.
  • 27. Kansal R, Nadkarni T, Goel A. Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases. J Clin Neurosci. 2010;17:428–429
  • 28. Wakai S, Hashimoto K, Watanabe N, et al. Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective comparative study. Neurosurgery. 1990;26:771–773.
  • 29. Moon KS, Lee JK, Kim TS, et al. Contralateral acute subdural hematoma occurring after removal of calcified chronic subdural hematoma. J Clin Neurosci. 2007;14:283-286.
  • 30. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 2003; 74(7):937–43
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Beyin ve Sinir Cerrahisi (Nöroşirurji)
Bölüm Makaleler
Yazarlar

Vural Hamzaoglu 0000-0003-0249-7711

Proje Numarası -
Yayımlanma Tarihi 25 Aralık 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 71 Sayı: 3

Kaynak Göster

APA Hamzaoglu, V. (2018). Surgical Treatment Outcomes of Our Patients with Chronic Subdural Hematoma: A Review of Seventy Six Cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 71(3), 71-251. https://doi.org/10.4274/atfm.47955
AMA Hamzaoglu V. Surgical Treatment Outcomes of Our Patients with Chronic Subdural Hematoma: A Review of Seventy Six Cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Aralık 2018;71(3):71-251. doi:10.4274/atfm.47955
Chicago Hamzaoglu, Vural. “Surgical Treatment Outcomes of Our Patients With Chronic Subdural Hematoma: A Review of Seventy Six Cases”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71, sy. 3 (Aralık 2018): 71-251. https://doi.org/10.4274/atfm.47955.
EndNote Hamzaoglu V (01 Aralık 2018) Surgical Treatment Outcomes of Our Patients with Chronic Subdural Hematoma: A Review of Seventy Six Cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71 3 71–251.
IEEE V. Hamzaoglu, “Surgical Treatment Outcomes of Our Patients with Chronic Subdural Hematoma: A Review of Seventy Six Cases”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 71, sy. 3, ss. 71–251, 2018, doi: 10.4274/atfm.47955.
ISNAD Hamzaoglu, Vural. “Surgical Treatment Outcomes of Our Patients With Chronic Subdural Hematoma: A Review of Seventy Six Cases”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71/3 (Aralık 2018), 71-251. https://doi.org/10.4274/atfm.47955.
JAMA Hamzaoglu V. Surgical Treatment Outcomes of Our Patients with Chronic Subdural Hematoma: A Review of Seventy Six Cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71:71–251.
MLA Hamzaoglu, Vural. “Surgical Treatment Outcomes of Our Patients With Chronic Subdural Hematoma: A Review of Seventy Six Cases”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 71, sy. 3, 2018, ss. 71-251, doi:10.4274/atfm.47955.
Vancouver Hamzaoglu V. Surgical Treatment Outcomes of Our Patients with Chronic Subdural Hematoma: A Review of Seventy Six Cases. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71(3):71-251.
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