Melih BOZKURT, Nihat EGEMEN, Hasan Çaglar UĞUR, Gökmen KAHİLOĞULLARI, Mevci ÖZDEMİR

Subaraknoid kanama ve komplikasyonlarının tedavisi

Subaraknoid kanama kanın subaraknoid mesafeye dağıldığı patolojik bir durumdur ve orta-ileri yaşgrubunda önemli bir morbidite ve mortalite nedenidir. Subaraknoid kanamalı bir hastanın tedavi- sinde primer hedef anevrizma kesesinin tamamının, rezidü bırakmadan güvenli bir şekilde oklüdeedilmesidir. Ancak yalnızca anevrizma kesesini oklüde etmek yeterli olmayıp subaraknoid kanama- ya bağlı meydana gelen komplikasyonlarda dikkatlice tedavi edilmelidir. Bu komplikasyonların baş- lıcaları; tekrar kanama, vazospazm, parankimal hematom, intraventriküler hemoraji, hidrosefali veintrakranial basınç artışıdır. Anevrizma tedavisinde hastaların monitörize edilerek yakın bir şekildetakip edilmesi ve bu komplikasyonların gelişmesi halinde erken tanı konularak müdahale edilmesipostop morbidite ve mortalite oranlarını büyük oranda azaltacak ve başarı oranını arttıracaktır.

Management of subarachnoid hemorrhage and complications: Review

Subarachnoid hemorrhage is a pathologic condition that exists when the blood spread through thesubarachnoid space and it is an important cause of morbidity and mortality in middle-age group.A primary goal in the treatment of patients with subarachnoid hemorrhage is to occlude the aneu- rysm sac entirely and safely without leaving a residue. However, not only occlusion of aneurysm ssac is adequate but also the complications that occurs due subarachnoid hemorrhage should betreated carefully. Recurrence of bleeding secondary to aneurysm bleeding, vasospasm, parenchy- mal hematomas, intraventricular hemorrhage, complications such as hydrocephalus and increasedintracranial pressure are important factors known to cause increased morbidity. Morbidity andmortality rates will decrease greatly, if close monitorization and early intervention is done for thepatients of aneurysms to prevent postoperative complications.

PDF

___

Ozdemir M, KahilogullarıG, Comert A, Caglar YS, Elhan A, Sılav G, Ugur HC. Pro- cessus clinoideus anterior ve posterior arası köprüleşme ve foramen caroticoclinoidale: anatomik çalışma. Ankara Universitesi Tıp Fakultesi Mecmuası 2006; 59: 175-8.
Yasargil M, Fox J. The microsurgical ap- proach to intracranial aneurysms. Surg Neu- rol; 1975;3: 7-14.
Yasargil M. Microneurosurgery, Vol. II. Stuttgart: Georg Thieme Verlag; 1984; 165- 221.
Rinkel GJ, Djibuti M, Algra A: Prevalance and risk of rupture of intracranial aneu- rysms: A systematic review. Stroke 1998; 29: 251-256.
Mc Fadzen RM, Doyle D, Rampling R, Teasdale E, Teasdale G: Pituitary apoplexy and its effects on vision. Neurosurg 1991; 29: 669-75.
McDonald RL, Weir B: Perioperatine Man- agement of Subarachnoid Hemorrhage. Youmans Fifth edition, Vol II, Philadelphia, Elsevier 1996; 1813-38.
Binet EF, Angtuaca EJC. Radiology of in- tracranial aneurysm. In Wilkins RH, New York. 1985; 1341-54.
Jayaraman MV, Mayo-Smith WW, Tung GA, et al. Detection of intracranial aneu- rysms: multi-detector row CT angiography compared with DSA. Radiology 2004; 230: 510-8.
Karamessini MT, Kagadis GC, Petsas T, et al. CT angiography with three-dimensional techniques for the early diagnosis of intra- cranial aneurysms. Comparison with intra- arterial DSA and the surgical findings. Eur J Radiol 2004; 49: 212-23.
Turkvatan A, Kelahmet E, Olcer T. İnternal karotid arter pseudoanevrizmasında radyolo-jik bulgular. Ankara Universitesi Tıp Fakul- tesi Mecmuası 2003; 56 (3): 193-6.
Wintermark M, Uske A, Chalaron M, et al. Multislice computerized tomography an- giography in the evaluation of intracranial aneurysms: a comparison with intraarterial digital subtraction angiography. J Neurosurg 2003; 98: 828-36.
Uysal E, Yanbuloglu B, Erturk M, Kilinc BM, Basak M. Spiral CT angiography in diagnosis of cerebral aneurysms of cases with acute subarachnoid hemorrhage. Diagn In- terv Radiol 2005; 11: 77-82.
Hernesniemi J, Dashti R, Lehecka M, Niemelä M, Rinne J, Lehto H, Ronkainen A, Koivisto T, Jääskeläinen JE. Microneuro- surgical management of anterior communi- cating artery aneurysms. Surgical Neurology 2008; 70: 829.
Kassel NF, Torner JC, Jane JA, et al: The in- ternational cooperative study on the timing of aneurysm surgery: II. Surgical results. J Neurosurg 1990; 73: 37-47.
Friedman AH: Timing of aneurysm surgery. In Wilkins RH, Rengachary SS (eds): Neu- rosurgery, 2nd ed. New York, McGraw-Hill, 1996, pp 2255-60.
Vinuela F, Duckwiler G, Mawad M: Gug- lielmi detachable coil embolization of acute intracranial aneurysm: Perioperative anatomical and clinical outcome in 403 pa- tients. J Neurosurg 1997; 86: 475-82.
Egemen N, Birler K, Avman N, Turker RK. Experimental cerebral vasospasm: Resolu- tion by Iloprost. Acta Neurochir 1988; 95: 131-5.
Egemen N, Birler K, Avman N, Turker RK. The effect of iloprost on experimental cere- bral arterial spasm in rabbit. Turkish Neuro- surgery Suppl 1989; 1: 113-5.
Egemen N, Turker RK, Sanlidilek U, Zor- lutuna A, Bilgic S, Baskaya M, Unlu A, Caglar S. The effect of intrathecal sodium nitroprusside on severe chronic vasospasm. Neurological Research 1993; 15: 308- 15.
Egemen N, Turker RK, Sanlidilek U, Zor- lutuna A, Bilgic S, Baskaya M, Unlu A, Caglar S. The effect of Iloprost on Chronic Cerebral Vasospasm. Gen. Pharmac. 1993; 24 (2): 403-9.
Egemen N, Baskaya MK, Turker RK, Unlu A, Caglar S, Guven C, Akbay C, Attar A. Protection by Iloprost (Stable Analogue of Prostacyclin) of endothelial damage due to chronic vasospasm in dogs: An electron microscope study. Neurological Research 1995; 17: 301-6.
Pasqualin A, Bazzan A, Cavanazzi P, et al: In- tracranial hematomas following aneurysmal rupture: Experience with 309 cases. Surg Neurol 1986; 25: 6-17.
Findlay JM, Grace MG, Weir BK: Treat- ment of intraventricular hemorrhage with tissue plasminogen activator. Neurosurgery 1993; 32: 941-7.
Selcuki D, Selcuki M: Aneurysmal Sub- arachnoidal Hemorrhage. Turkiye Klinikleri J Int Med Sci 2005; (1) 5: 43-8.
Hasan D, Tanghe HL: Distribution of cister- nal blood in patients with acute hydrocepha- lus after subarachnoid hemorrhage. Ann Neurol 1992; 31: 374-8.
Selcuki D, Selcuki M: Aneurysmal sub- arachnoidal hemorrhage: post hemorrhagic complications. Turkiye Klinikleri J Int Med Sci 2006; (2) 22: 79-84.
Solenski NJ, Haley ECJ, Kassel NF, et al: Medical complications of aneurysmal sub- arachnoid hemorrhage: A report of the multicenter, cooperative aneurysm study. Participants of the multicenter cooperative aneurysm study. Crit Care Med 1995; 23: 1007-17