Anevrizmal Subdural Hematomlarda Anevrizma Morfolojisi ve Perianevrizmal Ortamın Önemi

Abstract

Amaç: Nadir rastlanan anevrizmal subdural hematom (anSDH) oldukça yüksek mortaliteye sahiptir. Bu çalışma anevrizma yerleşimi ve klinik sonuçları karşılaştırılarak morfoloji ve perianevrizmal ortam arasındaki ilişkiye odaklanmıştır. Gereç ve Yöntemler: Anevrizmal subaraknoid kanaması olan toplam 486 hasta, eşlik eden subdural hematom (SDH) olguları açısından retrospektif olarak analiz edildi. Demografik bilgiler, tekrar kanama, taburculuk ve 6 aylık modifiye Rankin skalası (olumlu ve olumsuz) kaydedildi. Anevrizmalar 3 gruba ayrıldı: internal karotid arter (internal carotid artery, ICA), anterior serebral arter (anterior cerebral artery, ACA), ve orta serebral arter (middle cerebral artery, MCA). Diğer parametreler arasında anevrizma morfolojisi, SDH genişliği, intraserebral hematom (intracerebral hematoma, ICH) hacmi, intraventriküler hematom varlığı ve subdural boşluğa olan mesafe yer aldı. Bulgular: Eşlik eden SDH 19 (%3,9) hastada tespit edildi. Anevrizmaların 10'u (%52,6) ICA, 8'i (%42,1) MCA ve biri (%5,3) ACA'da yerleşmişti. Ortalama boyut 9,5±4,3 mm idi ve ICA ile MCA arasında anevrizma boyutu açısından anlamlı bir fark vardı (p=0,025). Altı supraklinoid anevrizmada (posterior komünikan ve anterior koroidal arterler) anevrizma kubbesi inferior lateral projeksiyonda idi. Modifiye Rankin skalasına göre olumlu ve olumsuz değerlendirilen hastalar arasında artmış ICH hacmi (p=0,020) ve orta hat kayma etkisi (p=0,030) dışında klinik ve anevrizma morfolojik özellikleri açısından anlamlı bir fark gözlenmedi. Sonuç: ICA supraklinoid segment anevrizmalarının boyutu ve kubbe projeksiyonu SDH için önemli risk faktörleri olabilir. Ayrıca, anevrizma lokalizasyonunun SDH bağlamında klinik sonuçlar üzerinde sınırlı bir etkiye sahip olabileceğine inanıyoruz.

Keywords

• Subdural Hematom
• Anevrizma morfolojisi
• Perianevrizmal ortam

The Importance of Aneurysm Morphology and Perianeurysmal Environment in Aneurysmal Subdural Hematomas

Abstract

Aim: Aneurysmal subdural hematoma (anSDH) is an uncommon condition associated with significant mortality risk. This study focused on the relationship between morphology and the perianeurysmal environment by comparing aneurysm location and clinical outcomes. Material and Methods: A total of 486 patients with aneurysmal subarachnoid hemorrhage were retrospectively analyzed for accompanying subdural hematoma (SDH) cases. Demographic information, rebleeding, discharge, and 6 months of the modified Rankin scale scores (favorable and unfavorable) were recorded. The aneurysms were divided into 3 groups: internal carotid artery (ICA), anterior cerebral artery (ACA), and middle cerebral artery (MCA). Other parameters included aneurysm morphology, SDH width, intracerebral hematoma (ICH) volume, the presence of intraventricular hematoma, and distance to the subdural space. Results: Concomitant SDH was detected in 19 (3.9%) patients. Aneurysms were located in the ICA, 10 (52.6%); MCA, 8 (42.1%); and ACA, one (5.3%). The mean size was 9.5±4.3 mm, and there was a significant difference in aneurysm size between the ICA and MCA (p=0.025). In six supraclinoid aneurysms (posterior communicating and anterior choroidal arteries), the aneurysm dome was in the inferior lateral projection. No significant differences were observed between patients with favorable and unfavorable modified Rankin scale in terms of clinical and aneurysm morphological characteristics, except for increased ICH volume (p=0.020) and shift effects (p=0.030). Conclusion: The size and dome projection of ICA supraclinoid segment aneurysms may be important risk factors for SDH. We also believe that aneurysm localization may have a limited impact on clinical outcomes in the context of SDH.

Keywords

• Subdural Hematoma
• Aneurysm morphology
• Perianeurysmal environment

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