The factors affecting the prognosis of surgically treated acute epidural hematoma patients: The retrospective analysis of 89 cases

Yıl 2019, Cilt: 12 Sayı: 3, 378 - 387, 31.12.2019

Hakan Özalp , Kaan Esen , Emel Avcı Tolga Akbıyık Ömer Ruşen Koyuncu Celal Bağdatoğlu Ahmet Dağtekin Vural Hamzaoğlu

https://doi.org/10.26559/mersinsbd.594262

Öz

Aim: The most
common cause of acute epidural hematoma (AEH) is parietotemporal bone fractures
due to injury of the arteria meningea media. In this study, we aimed to
investigate the factors affecting prognosis in patients operated with the
diagnosis of acute epidural hematoma in our clinic. Methods: Between 2007 and
2018, eighty-nine patients who were diagnosed as AEH in the Department of
Neurosurgery, Faculty of Medicine, Mersin University were included in the
study. Patients were divided into groups according to the age, initial Glasgow
coma scale (GCS), neurological findings, location, extent and operation of AEH.
The findings were compared according to mortality, morbidity, intensive care
and discharge period. Results: Seventy-five of the patients were
male, 14 were female and the mean age was 25.7 years. The most common
localization of the hematoma was parietotemporal region in 31 (34.8%)patients.
The hematoma was evacuated by craniotomy in 59 (66.3%) patients while
craniectomy was done in 30 (33%) patients for treatment. The worst clinical
outcomes were found in patients with GCS 8 and below after arrival. The
complications (44;0%) and mortality rates (52,0%) were found to be high in those
patients and the mean hospitilization period was found as 18.3 days. Conclusion: Early diagnosis and
treatment, the presence of high GCS, age less than 18 years and hematoma
thickness less than 20 mm were found to be associated with good prognosis,
while temporal location of the hematoma was predicted to be associated with
poor prognosis.

Anahtar Kelimeler

Acute epidural hematoma, craniotomy, Glaskow coma scale

Cerrahi olarak tedavi edilen akut epidural hematomlu hastalarda prognoz üzerine etki eden faktörler: Seksendokuz hastanın retrospektif analizi

Öz

Amaç: Akut epidural hematom
(AEH) kafa travması sonrası  sıklıkla
temporoparietal kemik kırıkları nedeni ile arteria meningea medianın
yaralanması sonucu görülmektedir. Bu çalışmada, kliğimizde akut epidural
hematom tanısı konularak opere edilen hastalarda, prognozu etkileyen
faktörlerin araştırılması amaçlanmıştır. Yöntem: Çalışmaya, 2007-2018
yılları arasında Mersin Üniversitesi Tıp Fakültesi Beyin ve Sinir Cerrahisi
Anabilim Dalı’nda AEH tanısı alarak cerrahi yöntemle tedavi edilen 89 hasta
dahil edilmiştir. Hastalar yaş
grupları, geliş Glasgow koma skalası (GKS), nörolojik bulguları, AEH’nin yeri,
genişliği ve yapılan operasyon şekline göre gruplara ayrılmıştır. Hastalarda
mortalite, morbidite, yoğun bakım ve hastane kalış sürelerine göre prognoz
kriterleri belirlenmeye çalışılmıştır. Bulgular:
Hastaların 75’i erkek, 14’ü kadın olup, ortalama yaş 25.7 olarak tespit
edildi. Hastalarda görülen en sık başvuru bulgusu şuur değişikliği idi (%66.9).
Hematomun en sık görüldüğü lokalizasyon 31 (%34.8) hastada parietotemporal
bölge olarak saptandı. Ellidokuz (%66.3) hastada kraniyotomi ile hematom
boşaltılırken, 30 (%33.0)  hastada
kraniektomi ile hematom boşaltıldı. En kötü klinik sonuçlar geliş GKS’si 8 ve
altında olan hastalarda tespit edilmiştir. Bu hastalarda komplikasyon (%44.0),
mortalite (%52.0) oranı oldukça yüksek ve hastanede yatış sürelerinin (ortalama
18.3 gün) uzun olduğu saptanmıştır. Hematom kalınlığı 20 mm üzerinde olan
hastalarda komplikasyon ve mortalite oranı yüksek bulunmuştur. Sonuç: AEH’de erken tanı ve tedavinin
yanısıra geliş GKS’sinin yüksek olması, hastanın yaşının 18’den daha küçük
olması ve hematom kalınlığının 20 mm’den küçük olması iyi prognozla ilişkili
olarak tespit edilmişken, hematomun temporal bölgede yer almasının kötü
prognozla ilişkili olabileceği öngörülmüştür. 

Anahtar Kelimeler

Akut epidural hematom, Kraniyotomi, Glasgow koma skalası

Kaynakça

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