Mücahit Avcil MD, ALİ YILMAZ, MÜCAHİT AVCİL, ZAHİR KIZILAY, Kubilay Murat ÖZDENER, Bayram ÇIRAK, Kadir TAHTA

Kafa Travmasında Kafa İçi Basınç ve Hipotalamo-Hipofizer- Gonadal Aks Arasındaki İlişkinin Değerlendirilmesi

Amaç: Kafa travmaları tüm travmatik yaralanmalar içinde önemli bir yer tutar ve ülkeler için önemli bir sağlık problemidir. Prognozu tahmin edici öngören yöntemlerin artması mortalite ve morbidite oranlarının azalmasını sağlayabilir. Gereç ve Yöntemler: Çalışmada 15 ağır kafa travmalı yetişkin erkek olguda sürekli intrakraniyal basınç (İKB) ölçümleri, ilk bilgisayarlı beyin tomografisi (BT), 0-4. günlerde büyüme hormonu, tiroid uyarıcı hormon, lüteinleştirici hormon, folikül uyarıcı hormon, prolaktin T3, T4 ve Te hormon düzeyleri ölçümü yapıldı. Bu

Evaluation of the Relationship of Intracranial Pressure with the Levels of HypothalamicPituitary-Gonadal Axis Hormones on Prognosis in Severe Brain Injury

Objective: Head traumas have an important place among all traumatic injuries and it is an important public health problem worldwide. Novel methods predicting prognosis may contribute to a decrease in the mortality and morbidity rates. Materials and Methods: Continuous intracranial pressure (ICP) measurements, initial cerebral computed tomography (CT) and measurement of the hypothalamicpituitary-gonadal (HPG) axis hormones between the 0th and 4th days were performed in 15 adult male patients with severe head trauma. The relationship of these parameters with the short-term results of the patients on the 15th day was evaluated. Additionally, provocation tests were carried out to evaluate the HPG axis function. Results: High ICP and compression of basal cisterna increased mortality and they were found to affect prognosis (p=0.009 and p=0.033, respectively) No statistically significant association was found between midline shift and prognosis. No relationship was found between mortality and mean basal hormone values on the 0th day and between the 1st and 4th days. Conclusion: ICP measurement values and the presence of compression of basal cistern on the initial brain CT can be used to predict the prognosis in severe head injury but there is no significant relationship between hypophyseal hormone values and prognosis.

PDF

___

1. Ökten AI, Ergun R, Beşkonaklı E, Akdemir G, Bostanci U, Gezici AR, ve ark. Kafa travmasında prognozu ve ölüm oranları etkileyen unsurlar. Türk Nöroşirürji Dergisi 1997: 7: 51-5.
2. Miller JD, Butterworth JF, Gudeman SK, Faulkner E, Choi SC, Selhorst JB, et al. Further experience in the management of severe head injury. J Neurosurg 1981: 54: 289-99.
3. Miller JD, Becker DP, Ward JD, Sullivan HG, Adams WE, Rosner MJ. Significance of intracranial hypertention in severe head injury. J Neurosurg 1977: 47: 503-16.
4. Kelly DF, Kordestani RK, Martin NA, Nguyen T, Hovda DA, Bergsneider M, et al. Hyperemia not following traumatic brain injury: relationship to intracranial hypertention and outcome. J Neurosurg 1996: 85: 762-71.
5. Silvergberg GD. Intrakranial presurre monitoring. In: Wilkins RH, Rengachary SS, editors. Neurosurgery 2nd ed. Newyork: McGraw Hill Companies, 1996 :185-90.
6. Saul TG, Ducker TB. Effect of intracranial pressure monitoring and agressive treatment on mortality in severe head injury. Neurosurg 1982: 56: 498-503.
7. Stocchetti N, Rossi S, Buzzi F, Mattioli C, Paparella A, Colombo A. İntrakranial hypertension in head injury: management and care results. Intensive Med 1999: 25: 371-6.
8. Tautant SM, Klaubar MR, Marshall LF, Toole BM, Bowers SA, Seeling JM, et al. Absent or basal combrressed sisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 1984: 61: 691-4.
9. Ross DA, Olsen WL, Ross AM, Andrews BT, Pitts LH. Brain shift in consciousness level of consciousness and restoration of Patients with acute intracranial hematoma. J Neurosurg 1989: 71: 498- 502.
10. Wardlaw JM, Easton VJ, Statham P. Which CT features help predict outcome after head injury? J Neurol Neurosurg Psychiatry 2002: 72: 188-92.
11. King LR, Knowles HC, Mc Laurin RL, Brielmaier J, Perisutti G, et al. Pituitary hormone response to head injury. Neurosurgery 1981: 9: 229-35.
12. Matsuura H, Nakazawa S, Wakabayashi I. Thyrotropin-releasing hormone provocative release of prolactin and thyrotropin in acute head injury. Neurosurgery 1985; 16: 791-5.