Murat YILMAZ, Alaattin YURT, İdiris LTUN, Hakan YILMAZ, Bilal KILIÇARSLAN, Nuri ARDA

Kronik Subdural Hematomlar: 94 Vakanın Derlenmesi

Amaç: Kliniğimizde kronik subdural hematom nedeniyle tedavi edilen hastaların risk faktörlerini, preoperatif bulgularını, komplikasyonları ve prognozlerını araştırmak. Materyal ve Metod: Ocak 2003 ve Aralık 2012 arasında kronik subdural hematom nedeniyle cerrehi olarak tedavi edilen hastalar retrospektif olarak incelendi. Hastaların ilk kabulü esnasındaki durumları ve etyolojileri not edildi. Kronik subdural hematomun kesin lokalizasyonu bilgisayarlı tomografi ile tespit edilip takipleri manyetik rezonans görüntüleme ile yapıldı. Sonuçlar bir ay sonra günlük hayat aktivite ölçümü ile değerlendirildi. Bulgular: Çalışmaya 94 hasta dahil edildi. Ortalama yaş 65 (45-85) idi. 74 dastada (%78.7) kafa travması orijini vardı. 20 hastada (%21.3) travma bugusu yoktu. Kabul sırasında en sık rastlanan semptom başağrısı (%100) ve en sık rastlanan bulgu konfüzyondu (%87.2). Hastaların çoğunluğunda hafif bir başağrısı mevcuttu ve Glascow Koma Skalası skoru sekizin üzerindeydi. %90.4 vaka tek bir ameliyatla tedavi edildi. %9.6 vakada ikinci bir işlem gerekti. Birinci ay kontrolde %91.5 hasta günlük hayat aktivitesine geri döndü. Sonuç: Kronik subdural hematomların cerrahi tadavisi yüksek oranda normal hayata dönüşü sağlayabilir

Anahtar Kelimeler:

Burr-hole kraniostomi; komplikasyon; kafa travması, kronik subdural hematom

Chronic Subdural Hematomas: A Review of 94 Cases

Purpose: To investigate risk factors, preoperative findings, treatment, complications and prognosis of patients with chronic subdural hematoma treated in our university. Material and Methods: Consecutive patients operated with a diagnosis of chronic subdural hematoma between January 2003 and December 2012 were reviewed retrospectively. Etiology and medical status of the patients at the time of admission were noted. Exact localization of the chronic subdural hematoma was detected by computed tomography scans and follow-up was maintained with magnetic resonance imaging. The outcome of the patients was evaluated one month after injury, by assesing activities of daily living. Results: Ninety-four consecutive patients met the eligibility criteria for the study. The mean age was 65 (range 45 to 85) years. In 74 (78.7%) patients, head injury was the supposed origin. In 20 (21.3%) patients, no trauma was evident. Most common symptom reported at the time of admission was headache (100%), and the most common neurological finding was confusion (87.2%). The majority of the patients had a mild neurological deficit with a Glascow Coma Scale score over eight. In general, 90.4% of cases were sufficiently treated by a single operation, while 9.6% needed a second procedure. During the follow-up, 91.5% of the patients returned to daily living activities on the first month kontrol. Conclusion: Surgical treatment of chronic subdural haematoma can give a high rate of complete recovery to normal life.

Keywords:

Burr-hole craniostomy; complications; head injury; chronic subdural hematoma,

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Reinges MH, Hasselberg I, Rohde V, Kuker W, Gilsbach JM. Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults. J Neurol Neurosurg Psychiatry. 2000;69:40-7
Sebastian A. Chronic subdural haematoma. A Dictionary of the History of Medicine. Pearl River, NY: Parthenon Publishing Group; 1999;201.
Rust T, Kiemer N, Erasmus A. Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy Journal of Clinical Neuroscience. 2006;13:823-7.
Amirjamshidia A, Eftekhara B, Abouzarib M, Rashidib A. The relationship between Glasgow coma/outcome scores and abnormal CT scan findings in chronic subdural hematoma Clinical Neurology and Neurosurgery. 2007;109:152-7.
Santarius T, Lawton R, Kirkpatrick PJ, Hutchison PJ. The management of primary chronic subdural haematomas: a questionnaire survey of practice in the United Kingdom and the Republic of Ireland. Br J Neurosurg. 2008;22:529-34.
Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiat. 2003;74:937-43.
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;42:43-6.
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.
Liliang PC, Tsai YD, Liang CL, Lee TC, Chen HJ. Chronic subdural haematoma in young and extremely aged adults: a comparative study of two age groups. Injury. 2002;33:345-8.
Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg. 2005;107:223-9.
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;41:371-81.
Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol 1997;47:418-22.