Hakan ÖZALP, Kaan ESEN, Emel AVCI, Tolga AKBIYIK, Ömer Ruşen KOYUNCU, Celal BAĞDATOĞLU, Ahmet DAĞTEKİN, Vural HAMZAOĞLU

Cerrahi olarak tedavi edilen akut epidural hematomlu hastalarda prognoz üzerine etki eden faktörler: Seksendokuz hastanın retrospektif analizi

Amaç: Akut epidural hematom (AEH) kafa travması sonrası sıklıkla temporoparietal kemik kırıkları nedeni ile arteria meningea medianın yaralanması sonucu görülmektedir. Bu çalışmada, kliğimizde akut epidural hematom tanısı konularak opere edilen hastalarda, prognozu etkileyen faktörlerin araştırılması amaçlanmıştır. Yöntem: Çalışmaya, 2007-2018 yılları arasında Mersin Üniversitesi Tıp Fakültesi Beyin ve Sinir Cerrahisi Anabilim Dalı’nda AEH tanısı alarak cerrahi yöntemle tedavi edilen 89 hasta dahil edilmiştir. Hastalar yaş grupları, geliş Glasgow koma skalası (GKS), nörolojik bulguları, AEH’nin yeri, genişliği ve yapılan operasyon şekline göre gruplara ayrılmıştır. Hastalarda mortalite, morbidite, yoğun bakım ve hastane kalış sürelerine göre prognoz kriterleri belirlenmeye çalışılmıştır. Bulgular: Hastaların 75’i erkek, 14’ü kadın olup, ortalama yaş 25.7 olarak tespit edildi. Hastalarda görülen en sık başvuru bulgusu şuur değişikliği idi (%66.9). Hematomun en sık görüldüğü lokalizasyon 31 (%34.8) hastada parietotemporal bölge olarak saptandı. Ellidokuz (%66.3) hastada kraniyotomi ile hematom boşaltılırken, 30 (%33.0) hastada kraniektomi ile hematom boşaltıldı. En kötü klinik sonuçlar geliş GKS’si 8 ve altında olan hastalarda tespit edilmiştir. Bu hastalarda komplikasyon (%44.0), mortalite (%52.0) oranı oldukça yüksek ve hastanede yatış sürelerinin (ortalama 18.3 gün) uzun olduğu saptanmıştır. Hematom kalınlığı 20 mm üzerinde olan hastalarda komplikasyon ve mortalite oranı yüksek bulunmuştur. Sonuç: AEH’de erken tanı ve tedavinin yanısıra geliş GKS’sinin yüksek olması, hastanın yaşının 18’den daha küçük olması ve hematom kalınlığının 20 mm’den küçük olması iyi prognozla ilişkili olarak tespit edilmişken, hematomun temporal bölgede yer almasının kötü prognozla ilişkili olabileceği öngörülmüştür.

Anahtar Kelimeler:

Akut epidural hematom, Kraniyotomi, Glasgow koma skalası

The factors affecting the prognosis of surgically treated acute epidural hematoma patients: The retrospective analysis of 89 cases

Aim: The most common cause of acute epidural hematoma (AEH) is parietotemporal bone fractures due to injury of the arteria meningea media. In this study, we aimed to investigate the factors affecting prognosis in patients operated with the diagnosis of acute epidural hematoma in our clinic. Methods: Between 2007 and 2018, eighty-nine patients who were diagnosed as AEH in the Department of Neurosurgery, Faculty of Medicine, Mersin University were included in the study. Patients were divided into groups according to the age, initial Glasgow coma scale (GCS), neurological findings, location, extent and operation of AEH. The findings were compared according to mortality, morbidity, intensive care and discharge period. Results: Seventy-five of the patients were male, 14 were female and the mean age was 25.7 years. The most common localization of the hematoma was parietotemporal region in 31 (34.8%)patients. The hematoma was evacuated by craniotomy in 59 (66.3%) patients while craniectomy was done in 30 (33%) patients for treatment. The worst clinical outcomes were found in patients with GCS 8 and below after arrival. The complications (44;0%) and mortality rates (52,0%) were found to be high in those patients and the mean hospitilization period was found as 18.3 days. Conclusion: Early diagnosis and treatment, the presence of high GCS, age less than 18 years and hematoma thickness less than 20 mm were found to be associated with good prognosis, while temporal location of the hematoma was predicted to be associated with poor prognosis.

Keywords:

Acute epidural hematoma, craniotomy, Glaskow coma scale,

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