Posterior Fossa Kraniyotomi: 85 Hastanın Retrospektif Analizi

Year 2024, Volume: 7 Issue: 2, 85 - 89, 30.06.2024

Kadir Oktay , Ebru Güzel , Emre Ünal Mansur Mammadov Hakan Seçkin , Aslan Güzel

https://doi.org/10.36516/jocass.1454355

Abstract

Amaç: Posterior fossa ameliyatlarında geleneksel olarak kranyektomi işlemleri yapılmaktadır. Ancak son yıllarda kraniyotomi işlemi de rutin olarak uygulanmaya başlanmıştır. Bu çalışmada posterior fossa kraniyotomi ameliyatı yapılan hastaları değerlendirmeyi amaçladık.
Gereç ve Yöntemler: 2016-2021 yılları arasında çeşitli patolojiler nedeniyle posterior fossa kraniyotomi uygulanan 85 hastanın kayıtları retrospektif olarak incelendi.
Bulgular: Hastaların yaş ortalaması 36,1 (2-82 yıl aralığı) idi. Hastaların 43'ü (%50,5) kadın, 42'si (%49,5) erkekti. Patolojiler 63 hastada tümör, 22 hastada ise tümör dışı idi. Tespit edilen hastaların semptomları baş ağrısı (%84,5), serebellar semptomlar (%68), bilinç bozukluğu (%54), mide bulantısı (%48), kranial sinir disfonksiyonu (%34) ve hemiparezi (%18,5) idi. Başvuru sırasında 22 hastada hidrosefali mevcuttu. Bu hastaların 12'sine ventriküloperitoneal şant uygulandı. 68 hastanın duramateri primer sütür ile kapatılırken, 17 hastaya fasya grefti ile duraplasti uygulandı. Kraniyotomi flepleri 75 hastada sadece ipek ile, 10 hastada ise mini plaklarla sabitlendi. Hastaların ikisinde psödomeningosel, birinde yaradan beyin omurilik sıvısı sızıntısı vardı. Mortalite oranı %3,5 idi. Ortalama hastanede kalış süresi 7,6 gün (2-54 gün arayla) idi.
Sonuç: Posterior fossa kraniyotomi tekniği son yıllarda yaygınlaşarak geleneksel kranyektomi tekniğinin yerini almaya başlamıştır. Teknolojinin ilerlemesiyle birlikte yüksek devirli drillerin kullanılmasıyla uygulanması kolaylaşmıştır. Posterior fossa kraniyotomi, ameliyat sonrası dönemde düşük komplikasyon oranları ve yüksek hasta konforu ile öne çıkan bir tekniktir.

Keywords

Posterior fossa, kraniyotomi, tümör, mikrovasküler dekompresyon, komplikasyon

Posterior Fossa Craniotomy: Retrospective Analysis of 85 Patients

Abstract

Aim: Craniectomy procedures were traditionally performed in posterior fossa surgeries. However, craniotomy procedure has also been started to be performed routinely in recent years. In this study, we aimed to evaluate the patients who underwent posterior fossa craniotomy procedures.
Methods: The records of 85 patients who underwent posterior fossa craniotomy for various pathologies between 2016-2021 were retrospectively reviewed.
Results: The mean age of the patients was 36.1 (2-82 years interval). There were 43 female patients (50.5%) and 42 male patients (49.5%). The pathologies was tumoral in 63 patients and non-tumoral in 22 patients. The symptoms of the patients identified were headache (84.5%), cerebellar symptoms (68%), deterioration of consciousness (54%), nause (48%), cranial nerve dysfunction (34%) and hemiparesis (18.5%). At admission, hydrocephaly was present in 22 patients. Ventriculoperitoneal shunt was applied to 12 of these patients. The duramater of the 68 patients were closed with primary suturation while 17 patients underwent duraplasty with fascia graft. Craniotomy flaps were fixed with only silk in 75 patients and miniplates in 10 patients. Two of the patients had pseudomeningocele and 1 had cerebrospinal fluid leak from the wound. The mortality rate was 3.5%. The mean duration of hospitalization was 7.6 days (2-54 days interval).
Conclusion: Posterior fossa craniotomy technique has recently become widespread and begun to replace traditional craniectomy technique. It was facilitated by using high-speed drill with the advancement in technology. Posterior fossa craniotomy is a prominent technique with the low complication rates and high patient comfort in the postoperative period.

Keywords

Posterior fossa, craniotomy, tumor, microvascular decompression, complication

References

• 1. Gnanalingham KK, Lafuente J, Thompson D, et al. Surgical procedures for posterior fossa tumors in children: does craniotomy lead to fewer complications than craniectomy? J Neurosurg. 2002;97(4):821-826.
• 2. Hadanny A, Rozovski U, Nossek E, et al. Craniectomy versus craniotomy for posterior fossa metastases: Complication profile. World Neurosurg. 2016;89:193-198.
• 3. Kuhn EN, Chagoya G, Agee BS, et al. Suboccipital craniotomy versus craniectomy: A survey of practice patterns. World Neurosurg. 2018;109:e731-738.
• 4. Legnani FG, Saladino A, Casali C, et al. Craniotomy vs. craniectomy for posterior fossa tumors: a prospective study to evaluate complications after surgery. Acta Neurochir (Wien). 2013;155(12):2281-2286.
• 5. Yasargil MG, Fox JL. The microsurgical approach to acoustic neurinomas. Surg Neurol. 1974;2(6):393-398.
• 6. Ogilvy CS, Ojemann RG. Posterior fossa craniotomy for lesions of the cerebellopontine angle-technical note. J Neurosurg. 1993;78(3):508-509.
• 7. Grover K, Sood S. Midline suboccipital burr hole for posterior fossa craniotomy. Childs Nerv Syst. 2010;26(7):953-955.
• 8. Hayward R. Posterior fossa craniotomy: an alternative to craniectomy. Pediatr Neurosurg. 1999;31(6):330.
• 9. Prell J, Scheller C, Alfieri A, et al. Midline craniotomy of the posterior fossa with attached bone flap: experiences in paediatric and adult patients. Acta Neurochir (Wien). 2011;153(3):541-545.
• 10. Sheikh BY. Simple and safe method of cranial reconstruction after posterior fossa craniectomy. Surg Neurol. 2006;65(1):63-66.
• 11. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): Surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery. 1997;40(1):11-21.
• 12. Kurpad SN, Cohen AR. Posterior fossa craniotomy: An alternative to craniectomy. Pediatr Neurosurg. 1999;31(1):54-57.
• 13. Missori P, Rastelli E, Polli FM, et al. Reconstruction of suboccipital craniectomy with autologous bone chips. Acta Neurochir (Wien). 2002;144(9):917-920.
• 14. Matsumoto K, Kohmura E, Kato A, et al. Restoration of small bone defects at craniotomy using autologous bone dust and fibrin glue. Surg Neurol. 1998;50(4):344-346.
• 15. Sawamura Y, Terasaka S, Ishii N, et al. Osteoregenerative lateral suboccipital craniectomy using fibrin glue. Acta Neurochir (Wien). 1997;139(5):446-451.
• 16. Tokoro K, Chiba Y, Murai M, et al. Cosmetic reconstruction after mastoidectomy for the transpetrosal-presigmoid approach: technical note. Neurosurgery. 1996;39(1):186-188.