Anevrizmatik Subaraknoid Kanamada Ultra-Erken ve Erken Tedavinin Etkileri: Tek Merkezli Retroprospektif Çalışma

Year 2024, , 67 - 71, 28.04.2024

Mehmetselim Gel , Emrah Keskin , İskender Samet Daltaban

https://doi.org/10.29058/mjwbs.1452463

Abstract

Amaç: Anevrizmal subaraknoid kanamaların (aSAK) cerrahi tedavisinin zamanlaması konusundaki
fikir ayrılıkları günümüzde hâlen devam etmektedir. Bu tartışmaya hastalığa bağlı sınırlamaların sebep
olduğu aşikâr olup; konuya yönelik çok sayıda araştırma mevcuttur. Bu çalışmalar özellikle erken ve
ultra erken cerrahiyi desteklemekle beraber; sonuçlar bu iki zamanlama içindeki tedavi seçeneklerinden
hangisinin (endovasküler tedavi (EVT) veya cerrahi tedavi (CT)) üstün olduğu konusunda da
henüz net değildir.
Gereç ve Yöntemler: Bu çalışma, Trabzon Kanuni Eğitim Araştırma Hastanesi Beyin ve Sinir Cerrahisi
Kliniğinde Haziran 2021 ile Haziran 2022 tarihleri arasında, aSAK tanısı ile tedavi edilen 50 hasta
üzerinde retroprospektif olarak yapılmıştır. Hastalar çalışmamızda tedavi yöntemine bakılmaksızın
(EVT veya CT) kanamanın ilk altı saat içinde tedavi edilenler ultra erken tedavi (Grup 1) ve altı saat-yirmi
dört saat arasında tedavi edilenler erken tedavi (Grup 2) olmak üzere iki ayrı gruba ayrıldı.
Bulgular: aSAK tanısıyla EVT veya CT ile tedavi edilen 50 hastanın 31’i erkek (%62) ve 19’u kadın
(%38) idi. Grup 1, 14’ü EVT ve 12’si CT ile olmak üzere toplam 26 hastadan; Grup 2 ise 13’ü EVT ve
11’i CT ile olmak üzere toplam 24 hastadan oluşmaktadır. Grup 1 ve Grup 2’deki hastalara gerek EVT
gerekse CT ile tedavi uygulanması durumunda istatistiksel olarak tedavinin tipi ve zamanlaması açısından
birbirine üstünlüğü olmadığı görülmüştür (Sırasıyla p=0,678, p=0,680).
Sonuç: Bu çalışma, aSAK tanılı hastaların klinik derecesine bakılmaksızın hem erken hem de ultra
erken dönemde yapılan her iki müdahalenin (EVT veya CT) sonuçları açısından farklılık olmadığını
göstermemiştir.

Keywords

Subaraknoid kanama, erken cerrahi, ultra-erken cerrahi, endovasküler tedavi, serebral anevrizma cerrahisi

Effects of Ultra-Early and Early Treatment in Aneurysmatic Subarachnoid Hemorrhage: Single Center Retroprospective Study

Abstract

Aim:There are on going disagreements about when to perform surgical treatment for aneurysmal
subarachnoid hemorrhage (aSAH), which is caused by limitations related to the disease. There is a lot
of research on this topic. However, it is stil lunclear which of the two treatment options (endovascular
therapy (EVT) or surgical therapy (CT)) is superior, despite studies that suggest early and ultra-earlysurgery as effective options.
Material and Methods: This retrospective study was carried out on 50 patients diagnosed with aSAH and treated at Trabzon Kanuni
Training and Research Hospital Brain and Nerve Surgery Clinic between June 2021 and June 2022. In this study, all patients, regardless
of their treatment method (EVT or CT), were divided into two groups based on the timing of their surgery: ultra-early treatment (Group 1),
where patients were treated with int he first six hours of bleeding, and early treatment (Group 2), where patients were treated between six
and twenty-four hours.
Results: Of the 50 patients diagnosed with aSAH and treated with EVT or CT, 31 were male (62%) and 19 were female (38%). Group 1
consists of a total of 26 patients, 14 with EVT and 12 with CT; Group 2 consists of a total of 24 patients, 13 with EVT and 11 with CT. If
patients in Group 1 and Group 2 were treated with either EVT or CT, it was observed that there was no statistical superiority to each other
in terms of the type and timing of treatment (p=0.678, p=0.680, respectively).
Conclusion: This study did not show that there was no difference in the outcomes of both interventions (EVT or CT) performed both in
the early and ultra-early period in patients diagnosed with aSAH, regardless of clinical grade.

Keywords

Subarachnoid hemorrhage, early surgery, ultra-early surgery, endovascular treatment, cerebral aneurysm surgery

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