Surgical Treatment Outcomes of Our Patients with Chronic Subdural Hematoma: A Review of Seventy Six Cases

Abstract

Objectives: Chronic subdural hematomas (CSH) are generally the intracranial hematomas seen in the middle and elder aged group. The hemorrhage is formed as a result of stretched parasagittal bridge veins due to cerebral atrophy. The patients’ outcome that underwent surgery because of CSH was investigated in our clinic. Materials and Methods: Seventy-six operated CSH patients were included to the study in the University of Mersin, Faculty of Medicine between 2008 and 2016. The patients were divided into two groups with the drainage of burr-hole and craniotomy and evaluated in terms of clinical outcome retrospectively. Results: There are 52 male, 24 female patients with the mean age of 64.8 detected in the group. The most common initial symptom at admission is headache (52.6%). The head trauma was reported in 28 (36.8%) patients. The use of anticoagulant drug in 18 patients (23.6%) and also at least one comorbid disease in 38 patients (50%) were detected among CSH. The most common localization for the hematoma was left fronto parietooccipital in 26 patients (34.2%). Burr-hole in 65 (85.5%) patients, craniotomy in 11 (14.5%) patients were performed for the evacuation of the CSH. The mean thickness of all the hematomas was detected as 22.0 mm and the mean midline shift was measured as 6.8 mm. The complication rate was 26.6% in the group with burr-hole whereas it was 0.9% in the group with craniotomy. The mortality was 4.6% (3 cases) in the burr-hole group, 18.1% (2 cases) in the craniotomy group. Conclusion: The choice of surgical treatment modality was still controversy in the management of CSH that leads to morbidity and mortality which is most commonly seen in elder patient group. While the complication rate was being resulted as high in the group evacuated with burr-hole, the mortality was particularly high in the group with craniotomy.

Keywords

• Chronic Subdural Hematoma
• Burr-Hole
• Craniotomy

Kronik Subdural Hematomlu Hastalarda Cerrahi Tedavi Sonuçlarımız: Yetmiş Altı Hastanın Analizi

Abstract

Amaç: Kronik subdural hematomlar (KSH) genellikle orta ve ileri yaşta görülen intrakraniyal kanamalardır. Serebral atrofi nedeniyle gerilen parasagital köprü venlerin kanaması sonucu görülmektedirler. Kliniğimizde KSH nedeniyle cerrahi olarak tedavi edilen hastaların sonuçları araştırılmıştır. Gereç ve Yöntem: 2008-2016 yılları arasında Mersin Üniversitesi Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı’nda KSH tanısı alarak cerrahi yöntemle tedavi edilen 76 hasta çalışmaya dahil edilmiştir. Hastalar burr hole ile hematom drenaj ve kraniyotomi ile hematom drenajı olmak üzere iki gruba ayrılarak klinik sonuçlar açısından retrospektif olarak değerlendirilmiştir. Bulgular: Hastaların 52’si erkek, 24’ü ise kadın ve ortalama yaş 64,8 olarak tespit edildi. Hastalarda görülen en sık başvuru şikayeti baş ağrısı olarak saptandı (%52,6). Yirmi sekiz hastada (%36,8) geçirilmiş bir kafa travması olduğu belirlendi. Antikoagülan ilaç kullanımı 18 hastada (%23,6) tespit edilirken, 38 hastada (%50) komorbiditeye neden olabilecek en az bir hastalık belirlendi. Hematomun en sık görüldüğü lokalizasyon ise 26 hastada (%34,2) sol frontoparietooksipital bölge olarak saptandı. Altmış beş olguda (%85,5) burr hole ile 11 olguda ise (%14,5) kraniyotomi ile hematom boşaltıldığı tespit edildi. Tüm hastalardaki ortalama hematom kalınlıkları 22,0 mm iken, ortalama orta hat şiftleri 6,8 mm olarak tespit edildi. Burr hole ile hematom drenajı yapılan hastalarda komplikasyon oranı %26,6 iken kraniyotomi ile opere edilen hastalarda bu oran %0,9 olarak belirlendi. Mortalite burr hole grubunda 3 olguda (%4,6) ve kraniyotomi grubunda ise 2 olguda (%18,1) saptandı. Sonuç: İleri yaş grubunda oldukça sık görülen ve cerrahi tedavi yöntemleri geniş oranda morbidite ve mortaliteye yol açabilen KSH’de tedavisinde seçilecek cerrahi yöntem hala tartışmalıdır. Burr hole ile hematom drenajı daha yüksek komplikasyon oranları ile sonuçlanırken kraniyotomi uygulanan olgularda ise mortalite oldukça yüksek oranda tespit edilmiştir.

Keywords

• Kronik Subdural Hematom
• Burr Hole
• Kraniyotomi

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