Sevil ARSLAN, Hümeyra KULLUKÇU ALBAYRAK, Mehmet Özgür ÖZATEŞ, Atilla KAZANCI, Ahmet Gürhan GÜRÇAY, Oktay GÜRCAN, Giyas AYBERK

İntrakraniyal anevrizmalı olguların demografik, klinik ve radyolojik bulgularının incelenmesi: 107 olgu, tek merkez deneyimi

Amaç: Anevrizma tanısı konularak yatırılan, cerrahi ve endovasküler tedavi uygulanan intrakraniyal anevrizmalıolguların, demografik, klinik-radyolojik bulgularının ve bu bulgularla ölüm oranlarının ilişkisinin retrospektif olarakincelenmesi amaçlandı.Gereç ve yöntem: Kraniyal bilgisayarlı tomografi ile teşhis konulduktan sonra anevrizmaların lokalizasyonu,bilgisayarlı tomografi anjiyografi veya dinamik serebral anjiyografi ile tesbit edilen 101 hastaya standart açıkmikrocerrahi, 7 hastaya ise endovasküler cerrahi yolla embolizasyon yapıldı. Geçici klip 30 sn ile 4 dk arasındadeğişen sürelerde (ortalama 2 dk) kullanıldı. Kalıcı klip konulduktan sonra ponksiyon yapılarak anevrizmaboynunun tam olarak oblitere edildiği doğrulandı. İntraoperatif kontrollü hipotansiyon ve profilaktik antibiyotikuygulandı.Bulgular: Olguların 75’i (%70,09) kadın, 32’si (%29,9) erkekti. Kadın/erkek oranı 2,34 idi. Olguların yaşortalaması 51,9 saptandı. En sık görülen ilk şikâyet 75 hastada (%70,09) baş ağrısı ve kusma idi. 107 olgunun85 (%79,4)’inde kraniyal BT’de SAK pozitif iken 22 (%20,5)’sinde negatif idi. En sık yerleşim yeri 49 olgu(%45,79) ile orta serebral arter idi. Klinik vazospazm gelişen 23 olgunun Fisher sınıflamaları değerlendirildiğinde;2 hastada Evre 1, 7 hastada Evre 2, 8 hastada Evre 3, 6 hastada Evre 4 tespit edildi. Vazospam gelişenhastaların 18 tanesi eksitus olurken, bu hastaların 7 tanesi ilk 24 saat içinde, 5’i 24-48 saat içinde, 6’sı 48 saatsonrasında opere edildi. 64 hasta operasyon sonrası sekelsiz olarak iyileşirken, 12 hastada hafif-orta düzeydesekel (hemiparazi, mitoz), 3 hastada şant ihtiyacı gerektiren hidrosefali gelişti. Hunt-Hess sınıflamasına göre16’sı Evre 4-5 olan total 31 olgu eksitus oldu.Sonuç: İntraserberal anevrizma tedavisinde sonucu etkileyen faktörlerin başında, ilk geliş anındaki nörolojikmuayene, anevrizmanın çoğul olması, Hunt-Hess Evre 4-5 kanamalar ve intraserebral hematom varlığıgelmektedir. Tekrar kanama riski ve ameliyat sonrası vazospam ile güvenli mücadeleye olanak sağlamasınedeni ile erken cerrahinin uygun tedavi zamanlaması olduğunu düşünmekteyiz.

Anahtar Kelimeler:

Subaraknoid kanama, anevrizma, demografik özellikler, anevrizma tedavisi

Investigation of demographic, clinical and radiological findings of cases with intracranial aneurysm: 107 cases, single center experience

Aim: It was aimed to retrospectively examine the demographic, clinical-radiological findings of patients withintracranial aneurysm who were hospitalized with the diagnosis of aneurysm and underwent surgical andendovascular treatment, and the relationship between these findings and mortality rates.Material and methods: After diagnosis with cranial computed tomography, the localization of aneurysms wasdetermined by computed tomography angiography or dynamic cerebral angiography, 101 patients underwentstandard open microsurgery, and 7 patients underwent embolization by endovascular surgery. Temporary clipswere used for 30 seconds to 4 minutes (average 2 minutes). Complete obliteration of the aneurysm neckwas confirmed by puncture after the permanent clip was placed. Intraoperative controlled hypotension andprophylactic antibiotics were administered.Results: 75 (70.09%) of the cases were female and 32 (29.9%) were male. The female/male ratio was 2.34.The mean age of the cases was 51.9 years. The most common first complaint was headache and vomiting in75 patients (70.09%). While 85 (79.4%) of 107 patients were positive in cranial CT, SAH was negative in 22(20.5%). The most common location was the middle cerebral artery with 49 cases (45.79%). When the Fisherclassifications of 23 patients with clinical vasospasm were evaluated, two patients were Grade 1, 7 patientswere Grade 2, 8 patients were grade 4, and 6 patients were grade 4v. While 18 of the patients who developedvasospasm died, 7 of these patients were operated on within the first 24 hours, 5 within 24-48 hours, and 6after 48 hours. While 64 patients recovered without sequelae after the operation, mild to moderate sequelae(hemiparesis, mitosis) developed in 12 patients and hydrocephalus requiring shunt in 3 patients. According tothe Hunt-Hess classification, a total of 31 patients died, 16 of whom were Stage 4-5.Conclusion: The main factors affecting the outcome in the treatment of intracerebral aneurysm are neurologicalexamination at the time of first presentation, multiple aneurysms, Hunt-Hess Stage 4-5 hemorrhages and thepresence of intracerebral hematoma. We think that early surgery can be used for appropriate treatment becauseof the risk of re-bleeding and the safe fight against vasospasm after surgery.

Keywords:

Subarachnoid hemorrhage, aneurysm, demographic features, cerebral aneurysm treatment,

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