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

Öz

Amaç: Anevrizma tanısı konularak yatırılan, cerrahi ve endovasküler tedavi uygulanan intrakraniyal anevrizmalı
olguların, demografik, klinik-radyolojik bulgularının ve bu bulgularla ölüm oranlarının ilişkisinin retrospektif olarak
incelenmesi 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 açık
mikrocerrahi, 7 hastaya ise endovasküler cerrahi yolla embolizasyon yapıldı. Geçici klip 30 sn ile 4 dk arasında
değişen sürelerde (ortalama 2 dk) kullanıldı. Kalıcı klip konulduktan sonra ponksiyon yapılarak anevrizma
boynunun tam olarak oblitere edildiği doğrulandı. İntraoperatif kontrollü hipotansiyon ve profilaktik antibiyotik
uygulandı.
Bulgular: Olguların 75’i (%70,09) kadın, 32’si (%29,9) erkekti. Kadın/erkek oranı 2,34 idi. Olguların yaş
ortalaması 51,9 saptandı. En sık görülen ilk şikâyet 75 hastada (%70,09) baş ağrısı ve kusma idi. 107 olgunun
85 (%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 gelişen
hastaların 18 tanesi eksitus olurken, bu hastaların 7 tanesi ilk 24 saat içinde, 5’i 24-48 saat içinde, 6’sı 48 saat
sonrasında opere edildi. 64 hasta operasyon sonrası sekelsiz olarak iyileşirken, 12 hastada hafif-orta düzeyde
sekel (hemiparazi, mitoz), 3 hastada şant ihtiyacı gerektiren hidrosefali gelişti. Hunt-Hess sınıflamasına göre
16’sı Evre 4-5 olan total 31 olgu eksitus oldu.
Sonuç: İntraserberal anevrizma tedavisinde sonucu etkileyen faktörlerin başında, ilk geliş anındaki nörolojik
muayene, anevrizmanın çoğul olması, Hunt-Hess Evre 4-5 kanamalar ve intraserebral hematom varlığı
gelmektedir. Tekrar kanama riski ve ameliyat sonrası vazospam ile güvenli mücadeleye olanak sağlaması
nedeni 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

Abstract

Aim: It was aimed to retrospectively examine the demographic, clinical-radiological findings of patients with
intracranial aneurysm who were hospitalized with the diagnosis of aneurysm and underwent surgical and
endovascular treatment, and the relationship between these findings and mortality rates.
Material and methods: After diagnosis with cranial computed tomography, the localization of aneurysms was
determined by computed tomography angiography or dynamic cerebral angiography, 101 patients underwent
standard open microsurgery, and 7 patients underwent embolization by endovascular surgery. Temporary clips
were used for 30 seconds to 4 minutes (average 2 minutes). Complete obliteration of the aneurysm neck
was confirmed by puncture after the permanent clip was placed. Intraoperative controlled hypotension and
prophylactic 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 in
75 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 Fisher
classifications of 23 patients with clinical vasospasm were evaluated, two patients were Grade 1, 7 patients
were Grade 2, 8 patients were grade 4, and 6 patients were grade 4v. While 18 of the patients who developed
vasospasm died, 7 of these patients were operated on within the first 24 hours, 5 within 24-48 hours, and 6
after 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 to
the 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 neurological
examination at the time of first presentation, multiple aneurysms, Hunt-Hess Stage 4-5 hemorrhages and the
presence of intracerebral hematoma. We think that early surgery can be used for appropriate treatment because
of 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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