Habibullah DOLGUN, Şahin HANALİOĞLU, Levent GÜRSES, Gülce GEL, İbrahim BAŞAR, Ahmet GÜNAYDIN, Erhan TÜRKOĞLU

Spontan İntraserebral Hematomların Cerrahi Tedavisi

Amaç: Bu çalışmanın amacı tüm inmelerin yaklaşık beşte birini oluşturan ve yüksek mortalite ve morbidite oranlarına sahip intraserebral hematomların İSH klinik-radyolojik özellikleri, cerrahi tedavi endikasyonları ve sonuçlarını geniş bir klinik seriden elde edilen tecrübeler ışığında analiz etmektir.Gereç ve Yöntem: Çalışmaya Ocak 2006 – Aralık 2017 tarihleri arasında, spontan İSH nedeniyle kliniğimizde ameliyat edilen 18 yaş üstü tüm hastalar dahil edildi. Hastaların epikriz kayıtları, radyolojik görüntüleri, ameliyat notları ve takip sonuçları retrospektif olarak incelendi. Yaş, cinsiyet, risk faktörü varlığı, başvuru anındaki nörolojik durum, hematomun lokalizasyonu ve hacmi, radyolojik özellikler, cerrahi teknik, postoperatif nörolojik sonuçlar, re-operasyon ve takip sonuçlarını içeren veriler toplandı.Bulgular: Spontan İSH nedeniyle toplam 88 hasta 30 kadın %34,1 , 58 erkek %65,9 opere edildi. Tanı anındaki yaş ortalaması 59,3±20,1 yıl aralık: 18–97, ortanca: 62 olarak hesaplandı. Başlıca başvuru semptom ve bulguları bilinç kaybı, bulantı-kusma, şiddetli baş ağrısı, ajitasyon, nöbet ve kuvvet kaybı hemipleji idi. Hastalar semptomların ortaya çıkışını takiben 20 dakika ile 5 saat arasında değişen sürelerde acile başvurdu. 74 hastaya %84,1 dekompresif hemikraniyektomi + hematom aspirasyonu, 14 hastaya %15,9 kraniyotomi + hematom aspirasyonu uygulandı. Ventriküle açılmış kanaması olan 58 hastanın %65,9 22’sinde %25 izlemde gelişen hidrosefali nedeniyle eksternal ventriküler drenaj EVD ihtiyacı oldu. Antiagregan/antikoagülan kullanımı olan 37 %42 hastanı 5’inde %5,7 tekrarlayan kanama veya hematom boyutunda artış gözlendi. Hastaların 47’si %53,4 kanamadan sonraki ilk 30 gün içinde hayatını kaybetti. GKS’si 8 ve daha düşük, kan hacmi ise 70 cm3’ün üzerinde olan hastalarda ise bu dönemde ölüm oranı %88 olarak bulundu.Sonuç: Antiagregan/antikoagülan kullanım öyküsü bulunan, yaşlı, hipertansif hastalarda daha yaygın görülen İSH mortalite ve morbiditesi oldukça yüksek bir hastalıktır. İleri yaş, çoklu yandaş hastalık varlığı, büyük hematom hacmi, başvuru anındaki düşük Glasgow koma skalası kötü prognoz ile ilişkilidir. Erken ve etkili cerrahi tedavi özellikle genç, yandaş hastalığı olmayan, nörolojik durumu nisbeten iyi veya ani kötüleşen hastalarda hayat kurtarıcı olabilmektedir

Surgical Treatment of Spontaneous Intracerebral Hematomas

Objective: Intracerebral hematomas ICH comprise one-fifth of all strokes and is associated with high mortality and morbidity rates. We aimed to analyze the clinical-radiological features, surgical treatment indications and results of spontaneous ICH in a large clinical series from a single institution.Materials and Methods: All patients who are older than 18 years of age and underwent surgery for spontaneous ICH between January 2006 and December 2017 were included. Patient charts, radiological images, operation notes and follow-up results were retrospectively evaluated. Data about age, sex, risk factors, neurological status at presentation, location and size of the hematoma, surgical technique, postoperative neurological outcomes, reoperation and follow-up results were collected.Findings: A total of 88 patients 30 female 34.1% , 58 male 65.9% were operated for spontaneous ICH. Mean age was 59.3±20.1 years range: 18–89, median: 62 . The main symptoms and signs were loss of consciousness, nausea-vomiting, severe headache, agitation, seizure and motor weakness hemiplegia . Patients were admitted at varying times from 20 minutes to 5 hours following the symptom onset. Decompressive hemicraniectomy + hematoma aspiration was performed in 74 84.1% patients whereas 14 patients underwent craniotomy + hematoma aspiration. External ventricular drainage was required in 22 25% of 58 patients 65.9% who had an intraventricular bleed. Recurrent bleeding or increased hematoma size was detected in 5 5.7% of 37 42% patients using antiaggregant/anticoagulant agents. Forty-seven 53.4% patients died within the first 30 days after bleeding. The 30-day mortality rate was 88% in patients with GCS ≤8 and blood volume >70 cm3.Conclusion: ICH is more common in elderly, hypertensive patients with a history of antiaggregant/anticoagulant use. The older age, multiple comorbid diseases, large hematoma volume, low GCS at presentation are associated with poor prognosis. An early and effective surgical treatment can be life-saving especially in patients who are young, have no comorbid disease and a relatively good neurological state or with a sudden worsening

Keywords:

intracerebral hematoma, hemorrhagic stroke, surgery, decompression, craniectomy,

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