Kraniyosinostoz Hastalarinda Kubbe Cerrahisinin, Cerrahi Öncesi ve Sonrası Parankimal Perfüzyon Üzerine Etkisinin İncelenmesi

Amaç: Çalışmamızda kliniğimizde tedavi edilen non-sendromik kraniyosinostoz olgularında cerrahi öncesi ve cerrahiden 12 hafta sonra çekilen ASL sekans perfüzyon MRG ile cerrahinin beyin perfüzyonu üzerindeki etkisinin incelenmesi amaçlanmaktadır. Gereç ve Yöntem: Çalışma 28.12.2021-16.09.2022 tarihleri arasında Ankara Şehir Hastanesi Beyin ve Sinir Cerrahi kliniğinde cerrahi tedavileri, preoperatif ve postoperatif tetkikleri gerçekleştirilen 10 hasta ile yapıldı. Hastalara preoperatif ve postoperatif 12. haftada Perfüzyon MRG çekimleri yapıldı. Preoperatif ve postoperatif elde edilen görüntüler çalışma istasyonunda karşılaştırmalı değerlendirildi. Bulgular: Çalışma kriterlerini karşılamayan hastaların çalışma dışında bırakılmasını takiben 9 hastanın sonuçları incelendi. Beş hastaya açık cerrahi rekonstrüksiyon dört hastaya endoskopik cerrahi uygulandı. Preoperatif ve postoperatif ortalama 87 gün sonra MRG çekimleri yapıldı. Cerrahi sonrası 7 hastada perfüzyon artışı ve 2 hastada perfüzyonda azalma oldu. Ortalama perfüzyon hızlarına bakıldığında artış saptanan yedi hastanın dördünde sonuçlar istatistiksel olarak anlamlıyken (p≤0,05) azalma görülen hastaların birinde sonuçlar istatistiksel olarak anlamlı bulundu. (p≤0,05) Sonuç: Non-sendromik kraniyosinostoz hastalarında cerrahi tedavi beyin perfüzyonu üzerinde etkilidir. Perfüzyon değişikliği cerrahi teknik, cerrahi sırasında hasta yaşı ve kraniyosinostoz çeşidine göre farklı olabilir. Cerrahi tedavi kozmetik düzelmenin yanında nörolojik fonksiyonların değişikliğinde de etkili olabilir. Kontrast gerektirmeyen ve non-invaziv olan ASL sekans perfüzyon MRG kraniyosinostoz hastalarında cerrahinin kantatif etkinliğini göstermede başarılı bir yöntemdir.

Anahtar Kelimeler:

Kraniyosinostoz, Manyetik Rezonans, Non-sendromik, Perfüzyon Görüntüleme, Serebral Kan Akımı

Investigation of the Effect of Cranial Vault Surgery On Parenchymal Perfusion Before and After Surgery in Craniosynostosis Patients

Objective: In our study, it is aimed to examine the effect of surgery on brain perfusion with ASL sequence perfusion MRI taken before surgery and 12 weeks after surgery in cases of non-syndromic craniosynostosis treated in our clinic. Materials and Methods: The study was conducted between 28.12.2021-16.09.2022 with 10 patients who evaluated preoperatively and treated surgically at the Neurosurgery Clinic of Ankara City Hospital. Perfusion MRI was performed preoperatively and 12 weeks postoperatively. The preoperative and postoperative images obtained were evaluated comparatively at the workstation. Results: After the exclusion of patients who did not appropriate the study criteria, the results of 9 patients were examined. MRI scans taken preoperatively and 87 days as average postoperatively. After surgery, there is perfusion enhancement in 7 patients and a perfusion impairment in 2 patients. About the average perfusion rates, the results were found to be statistically significant in four of the seven patients in whom an increase was detected (p≤0.05), while the results were found to be statistically significant in one of the patients in whom a decrease was observed. (p≤0.05) Conclusion: Surgical treatment is effective on brain perfusion in patients with non-syndromic craniosynostosis. Perfusion alteration may be different according to surgical technique, patient age at the time of surgery and type of craniosynostosis. In addition to cosmetic improvement, surgical treatment can also be effective in changing neurological functions. ASL sequence perfusion MRI, which doesn’t require contrast and is non-invasive, is a successful method of demonstrating the quantitative effectiveness of surgery in patients with craniosynostosis.

Keywords:

Cerebral Blood Flow, Craniosynostosis, Magnetic Resonance, Nonsyndromic, Perfusion Imaging,

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