Tekrarlayan kronik subdural hematomlar önceden öngörülebilir mi? 136 olgunun retrospektif analizi

Amaç: Kronik subdural hematom, özellikle yaşlılarda en sık saptanan intrakranyal kanama çeşididir. Genel kabul gören “burr-hole” ile hematom boşaltılması operasyonu sonrası, seyrek denilmeyecek bir ölçekte tekrarlama izlenebilir. Bu çalışmada, tekrarlamayı kolaylaştıran nedenlerin ortaya konması amaçlanmaktadır. Yöntem: Retrospektif olarak 136 olgu değerlendirilerek klinik parametreler, anamnez özellikleri, koagülasyon inhibitörleri kullanımlarının tekrarlama üzerine etkisi hem tek değişkenli hem de çok değişkenli testlerle araştırıldı. Bulgular: 136 olgunun, 27’sinde en az ikinci bir operasyon gerekmişti. Yapılan tek değişkenli ve çok değişkenli analizler sonucunda, hematomun bilateral olduğu hastalarda, tek taraflı olanlara göre, tekrarlamanın daha sık olduğu saptandı (sırası ile, %37, %11). Buna karşılık, cins, yaş, anamnezde hipertansiyon ya da diyabet mevcudiyeti, travma öyküsü ve süresi, antiagregan kullanımı gibi etkenlerin tekrarlama üzerinde etkisinin bulunmadığı izlendi. Sonuç: Çalışmamızda incelenen etkenlerden yalnızca hematomun bilateral olmasının tekrarlamayı etkilediği saptanmış olup, altta yatan muhtemel beyin atrofisi, koagülopati gibi nedenlerin buna yol açtığı düşünülmüştür.

Can recurrence of chronic subdural hematoma be predicted? a retrospective analysis of 136 cases

Objective: Chronic subdural hematoma is the most common intracranial hematoma effecting especially elderly population. There is a substantial recurrence rate after evacuation by burr-hole surgery. In this study, we aimed to determine predictors associated with recurrence. Methods: We retrospectively analyzed 136 consecutive patients with chronic subdural hematoma. Clinical parameters, anamnesis, previous anticoagulant drug use have been evaluated with univariate and multivariate analyses to determine predictors associated with recurrence Results: At least a second surgery was needed in 27 patients of 136. We showed that recurrence rate was significantly higher in patients with bilateral subdural hematoma, after univariate and multivariate analyses (37% versus 11%). We did not find any significant relationship between recurrence and age, gender, hypertension and/or diabetes mellitus in anamnesis, preceding head trauma and time interval, anticoagulant and/or antiaggregan therapy. Conclusion: After analysis of all evaluated factors, only bilateral hematoma was found correlated with high recurrence rate, probably due to previous brain atrophy or existing coagulopathy.

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Düşünen Adam - Psikiyatri ve Nörolojik Bilimler Dergisi-Cover
  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984
  • Yayıncı: Kare Yayıncılık