İntrakranial Anevrizmalarda Cerrahi Tedavi ile Endovasküler Tedavinin Karşılaştırılması

Amaç: Acil servisimize başvuran ve anevrizmal subaraknoid kanama SAK tanısı alan hastaların cerrahi ve endovasküler tedavilerinin verilerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Acil servisimize direk başvuran SAK’ı bulunan veya klinik olarak anevrizma şüphesi bulunan 86 hasta yaş, cinsiyet, risk fatörleri, geliş klinik semptomları, anevrizma lokalizasyonları, tek veya birden fazla anevrizmaya sahip oluşuna, Fischer indeksine göre gruplandırıldı. Cerrahi ve endovasküler tedavilerinin sonuçları girişim zamanına ve Glaskow Koma Skoruna GKS göre değerlendirildi. Vakaların geliş nörolojik tabloları ‘Hunt-Hess’ ve ‘World Federation of Neurosurgical Societies’ WFNS grade’ine göre, klinikten çıkış durumları ise GKS’ye göre değerlendirildi. Bulgular: Acil girişim gerektiren durumlarla beraber 24 saat-5 gün arası cerrahi sonuçlarını daha iyi saptadık. Nörolojik tablosu stabil, grade iyi olan hastalarda; cerrahi uygulanması zor, perforan dalları mevcut olan anevrizmalarda da 5-15 günler arası endovasküler tedavinin sonuçlarını daha iyi bulduk. Sonuç: Daha da ilerleyen teknoloji ve endovasküler tekniklerle daha yüksek sağ kalım ve düşük morbidite oranlarının endovasküler girişim lehine değişeceği kanısında olsak da, acil durumlarda cerrahi girişimin her zaman ilk tercih olması düşüncesindeyiz.

Anahtar Kelimeler:

Cerrahi tedavi, Endovasküler tedavi, Serebral anevrizma

Comparison of Surgical Treatment and Endovascular Treatment of Intracranial Aneurysms

Aim: We imed to comparison of endovascular and surgical treatment in patients with subarachnoid hemorrhage. Materials and Methods: 86 patients who applied our emergency service with subarachnoid hemorrhage, were classified according to their age, gender, risk factors, symptoms, localization of aneurysms, having single or multiple aneurysms and Fischer index. Results of surgical and endovascular treatment were evaluated due to time of intervention and Glaskow Coma Scale. Neurologic status of patients evaluated according to Hunt-Hess scale and World Federation of Neurosurgical Societies WFNS grading system at the time of application. The outcome of the patients defined with Glaskow Coma Scale. Results: Result of surgery was better in patients who needed emergency intervention and operated between 24 hours and 5 days. Results of endovascular treatment were better in patients with stable neurological status, low grade Hunt-Hess scale, aneurysms with perforating branches. Conclusion: Although endovascular treatment reduces the morbidity and mortality with developing technology and techniques, surgery is still the first choice in patients who need urgent intervention.

Keywords:

Cerebral aneurysms, Endovascular treatment, Surgical treatment,

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Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Maltepe Üniversitesi

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