Kronik Subdural Hematomda Burrhole Kraniostominin Etkinliği. Retrospektif 9 Yıllık Bir Çalışma

ÖZET Amaç: Kronik subdural hematom tanısı alan hastalara uygulanan Burr-hole kraniostomi cerrahi tekniğinin etkinliğinin, olası komplikasyonlarının, diğer cerrahi tekniklerle farkının gösterilmesidir. Gereç ve Yöntemler: Ordu Üniversitesi Eğitim ve Araştırma Hastanesi Nöroşirürji Kliniği'nde 01.01.2013-15.08.2022 tarihleri arasında kronik subdural hematom tanısı ile ameliyat edilen 36 hastanın cerrahi teknikleri ve ameliyat sonrası klinik ve radyolojik detayları retrospektif olarak incelendi. Olguların 28'i (%77.7) erkek, 8'i (%22.3) kadındı. Ortalama yaş 70, yaş aralığı 54-87 idi. Vakaların 10'unun GCS'si 15 (%28), 20'sinin GCS'si 13-14 (%56) ve 6'sının GCS'si 8-12 idi. Hastaların en belirgin şikayetleri baş ağrısı ve kafa karışıklığıydı. 22 hastada (%61.1) kafa travması öyküsü varken, 14 hastada (%38.9) travma öyküsü yoktu. 9 hastada (%25) antikoagülan veya antiagregan ilaç kullanım öyküsü mevcuttu. Ameliyat sonrası dönemde tüm hastalarda ilk 24 saat içinde kontrol beyin BT'si çekildi ve ameliyat öncesi BT ile karşılaştırıldı. Yine ameliyat sonrası 1.2. hafta ve 1. ay sonunda tüm hastalara kontrol beyin BT çekildi ve GKS ameliyat öncesi skorları ile karşılaştırıldı. Ameliyat sonrası komplikasyonlar belirlendikten sonra bu komplikasyonların tedavisi ve sonuçları incelendi. Bulgular: Post-op Dönemdeki bütün hastalara ilk 24 saat içerisinde kontrol beyin ct çekilmiş ve pre-op ct ile karşılaştırılmıştır. Yine bütün hastalara post-op 1.ve 2. Hafta ve 1. Ay sonunda kontrol beyin CT çekilmiş ve GKS pre-op dönemdeki skorları ile karşılaştırılmıştır. 6 hastaya post-op dönemde rezidü- nüks kanamalarının olması ve nörolojik durumlarında iyileşme olmaması nedeni ile kraniotomi + membranektomi ameliyatı yapılmıştır. Kraniotomi ile opere edilen hastalardan biri ileri dönemde sepsis nedeni ile eks olmuştur. Burr-Hole ile opere edilen 1 hastada post-op dönemde motor disfazi gelişmiş olup bu hastanın çekilen post-op tomografisinde intraparankimal kanama tespit edilmiştir. Bu hastanın post-op 1. ay sonunda disfazisi düzelmiştir. Burr-hole kraniostomi yapılan 9 hastada post-op dönemde pnömosefali gelişmesine rağmen cerrahi tedavi gerektirmemiş ve spontan rezorbe oldukları görülmüştür. Ayrıca Burr-hole kraniostmi yapılan 4 Hastada post-op dönemde yara yeri enfeksiyonu gelişmiştir. Bu hastalara uygun antibiyotik tedavisi verilmiştir.1.hafta sonunda 18 hastanın CT ile yapılan radyolojik incelemesinde rezidüel hematom ve nüks hematom izlenmemiştir. 10 hastanın radyolojik olarak düzelmesi 1.ay sonunda ve 7 hastanın radyolojik olarak düzelmesi 3.ay sonunda tamamlanmıştır. Burr-hole kraniostomi uygulanan hastaların post-op klinik ve radyolojik sonuçları pre-op klinik ve radyolojik sonuçlarına göre anlamı derecede iyiydi ve nüks oranı literatür ile uyumlu derecede düşüktü. Sonuç: Bur-hole kraniostomi ile kronik subdural hematomun drenajı kraniotomi yöntemine kıyasla daha fazla nüks oranına sahip olsada daha düşük komplikasyon oranına sahiptir ve daha kolay uygulanabilir bir cerrahi tekniktir. Çalışmamızda cSDH tahliyesi için burrhole kraniyostomi uygulanan hastalarda bazı önemli noktalar vurgulanmıştır. Burrhole kraniyostomi uygulanan hastalarımızın kraniyotomi uygulanan hastalarımıza göre daha yüksek reoperasyon oranlarına sahip olduğu gözlendi. Post-op dönemde BT ile yapılan kontrollerde rezidü hematom varlığının tekrar ameliyat için tek kriter olmaması gerektiğini düşünüyoruz. Hastanın nörolojik durumunda düzelme ve ameliyat sonrası izlemde daha iyi GKS skoru varsa BT kontrollerinin yeterli olduğunu düşünüyoruz.

Anahtar Kelimeler:

KRONİK SUBDURAL HEMATOM, BURR HOLE KRANİYOSTOMİ, KRANİYOTOMİ

Efficacy of Burrhole Craniostomy in Chronic Subdural Hematoma. A Retrospective 9-Year Study

Objective: To demonstrate the effectiveness, possible complications, and difference of Burr-hole craniostomy surgical technique applied to patients diagnosed with chronic subdural hematoma from other surgical techniques. Methods: The surgical techniques and postoperative clinical and radiological details of 36 patients who were operated on with the diagnosis of chronic subdural hematoma in the Neurosurgery Clinic of Ordu University Training and Research Hospital between 01.01.2013 and 15.08.2022 were retrospectively analyzed. In all patients in the post-op period, control brain CT was taken within the first 24 hours and compared with the pre-op CT. Again, at the end of post-op 1st, 2nd week and 1st month, control brain CT was taken for all patients and GCS was compared with pre-op scores. After determining the post-op complications, the treatment and results of these complications were examined. Results: One patient who was operated on with Burr-Hole developed motor dysphasia in the post-op period, and intraparenchymal hemorrhage was detected in the post-op tomography of this patient. . Post-op clinical and radiological results of patients who underwent burr-hole craniostomy were significantly better than pre-op clinical and radiological results, and the recurrence rate was low, consistent with the literature. All drains placed in the subdural area after the burr hole opened during the operation were removed before discharge. Conclusions: Although the drainage of chronic subdural hematoma with bur-hole craniostomy has a higher recurrence rate compared to the craniotomy method, it has a lower complication rate and is a more easily applicable surgical technique. In our study, some important points about patients who underwent burrhole craniostomy for cSDH evacuation were highlighted. It was observed that our patients who underwent burrhole craniostomy had higher reoperation rates compared to our patients who underwent craniotomy. We think that the presence of residual hematoma in the controls performed with CT in the post-op period should not be the sole criterion for re-operation. We think that CT controls are sufficient if there is improvement in the neurological status of the patient and a better GCS score in the post-op follow-up.

Keywords:

Chronic subdural Hematoma, Burr-Hole craniostomy, Craniotomy,

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