İntrakranial Anevrizmalı 60 Olgunun Geriye Dönük Olarak Değerlendirilmesi

Öz

Spontan subaraknoid kanama birçok nedene bağlı, her yaşta görülebilen serebrovaskü-ler bir olaydır ve en sık nedenini intrakranial anevrizmalar oluşturmaktadır. Bu çalışmada tedavi edilen intrakranial anevrizma vakalarının klinik ve nöroradyolojik özellikleri ve cerrahi sonuçları literatür ile karşılaştırılarak incelenmiştir. Atatürk Eğitim ve araştırma Hastanesi II. Nöroşirürji Kliniği’nde Ocak 2006 ve Nisan 2009 tarihleri arasında subaraknoid kanama geçiren 60 hastada intrakranial anevrizma tespit edilerek ameliyata alınmıştır. Preoperatif nörolojik tablo ve çıkış skalaları değerlendirilerek erken ve geç cerrahi uygulanan hastalar mevcut bulgular ile retrospektif olarak incelenmiştir. Kadın erkek oranı 3/2 idi. Yaş dağılımı 17 ile 77 arasında olup ortalama yaş 53,5 olarak tespit edildi. En sık anevrizma yerleşimi orta serebral arterdeydi. Hastaların 10’unda (% 16,9) çoğul anevrizma mevcuttu. Olguların %93,2’sine erken cerrahi, %6,8’ne geç cerrahi uygulanmıştır. Bir olguda endovasküler cerrahi yapıldı. Operasyon zamanı ve Glasgow sonuç skalası incelenerek yapılan çalışmada erken cerrahi uygulanan hastaların % 27,6’sında, geç cerrahi uygulanan hastaların ise % 53,8’inde vazospazm geliştiği, vazospazmın en sık Anterior Kominikan Arter anevrizmaları ve Dünya Nöroşirürjiyen-ler Topluluğu skorlamasına göre grade 3 anevrizmalarda görüldüğü çalışmamızda gösterilmiştir. Erken cerrahi yapılan hastalarda; morbidite ve mortalite açısından prognozun daha iyi olduğu görüldü. Dr. Giyas AYBERK Dr. Alpaslan EYLEN Dr. Mesut Emre YAMAN Dr. Timur YILDIRIM Dr. Hakan TOSUN Dr. NaciALTUNDAL Dr. Erdem GÜRKAŞ Dr. M. Faik ÖZVEREN

Anahtar Kelimeler

• Anevrizma
• disekan; subaraknoid kanama; vazospazm
• kafa içi

Retrospective Evaluation Of 60 Cases Of Intracranial Aneurysms

Öz

Subarachnoid hemorrhage is a multifactorial cerebrovascular disease that occurs in every age group and the rupture of aneurysm is the most common cause of strokes. In this study, we have investigated the clinical and neuroradiological findings and surgical results of the intracranial aneuryms treated at our clinic retrospectively. Sixty patients with intracranial aneurysms presented with subarachnoid hemorrhage had been operated on between January2006 and April 2009 at Ataturk Training and Research Hospital Department of neurosurgery. Patients operated were evaluated according to the preopeative findings and surgical outcomes. The female-male ratio was 3/2 and the age distribution was between 17 to 77 with mean 53,5. The most common aneurysm localization was middle cerebral artery. In 10% of the patients aneurysms were multiple. In 93,2 % of the patients early surgery and in the 6,8% of patients late surgery were performed. Endovascular surgery was carried out in one patient by way of aneurysm coiling. It has been pointed out in our study that vasospasm developed in 27,6 % of the patients operated early and in 53,8 % of the patients operated late. It has also been shown that this case of vasospasm is more prevalent in Anterior Communicating Artery aneurysms and grade 3 aneurysms according to WFNS grading system. In patients operated on early prognosis was better regarding morbidity and mortality.

Anahtar Kelimeler

• Aneurysm
• Dissecting; subarachnoid hemorrhage; vasospasm
• intracranial

Kaynakça

1. 1. Van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet. 2007 27; 306-18. 4.
2. 2. Kopİtnik TA, Samson DS. Management of subarachnoid haemorrhage. J Neurol Neu-rosurg Psychiatry. 1993; 56: 947-59.
3. 3. de Toledo P, Rios PM, Ledezma A, Sanchis 5. A, Alen JF, Lagares A. Predicting the outcome of patients with subarachnoid hemorrhage using machine learning techniques. IEEE Trans Inf Technol Biomed. 2009; 13: 794-801.
4. 4. lldan F, Tuna M, Erman T, Göçer Al, Cetinalp E, Burgut R. Prognosis and prognostic factors for unexplained subarachnoid hemorrhage: review of 84 cases. Neurosurgery. 2002; 50: 1015-24.
5. 5. Kang SD. Emergent Clipping without Prophylactic Decompressive Craniectomy in Patients with a Large Aneurysmal Intracerebral Hematoma. J Korean Neurosurg Soc. 2008; 44: 353-7.
6. 6. Oshiro EM, Walter KA, Piantadosi S, Witham TF, Tamargo RJ. A new subarachnoid hemorrhage grading system based on the Glasgow Coma Scale: a comparison with the Hunt and Hess and World Federation of Neurological Surgeons Scales in a clinical series. Neurosurgery. 1997; 41: 140-7.
7. 7. Jeong YG, Jung YT, Kim MS, Eun CK, Jang SH. Size and location of ruptured intracranial aneurysms. J Korean Neurosurg Soc. 2009; 45: 11-5.
8. 8. Gambhir S, O’Grady G, Koelmeyer T. Clinical lessons and risk factors from 403 fatal cases of subarachnoid haemorrhage. J Clin Neurosci. 2009; 16: 921-4.

9. 9. Yaşargil MG. Microneurosugery. Stutgart, Georg Thieme Verlag, 1984, vol. 1-vol 2.
10. 10. Locksley HB, Sahs AL, Sandler R. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. 3. Subarachnoid hemorrhage unrelated to intracranial aneurysm and A-V malformation. A study of associated diseases and prognosis. J Neurosurg. 1966; 24:1034-56.
11. 11. Pakarinen S. Incidence, aetiology, and prognosis of primary subarachnoid haemorrhage. A study based on 589 cases diagnosed in a defined urban population during a defined period. Acta Neurol Scand. 1967; 43: 1-28.
12. 12. Kassell NF, Drake CG. Timing of aneurysm surgery. Neurosurgery. 1982; 10: 514-9.
13. 13. Diringer MN. Management of aneurysmal subarachnoid hemorrhage. Crit Care Med. 2009; 37: 432-40.
14. 14. Kassell NF, Tomer JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg. 1990; 73: 18-36.
15. 15. Ohman J, Heiskanen O. Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study. J Neurosurg. 1989; 70: 55-60.
16. 16. Ishibashi T, Murayama Y, Urashima M, Sa-guchi T, Ebara M, Arakawa H, et al. Unruptured intracranial aneurysms. Incidence of rupture and risk factors. Stroke, 2009; 40: 313-6.
17. 17. Ljunggren B, Sâveland H, Brandt L, Zygmunt S. Early operation and overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg. 1985; 62: 547-51.
18. 18. Hillman J, von Essen C, Leszniewski W, Johansson I. Significance of “ultra-early” rebleeding in subarachnoid hemorrhage. J Neurosurg. 1988; 68:901-7.
19. 19. Ohman J. Hypertension as a risk factor for epilepsy after aneurysmal subarachnoid hemorrhage and surgery. Neurosurgery. 1990; 27: 578-81.
20. 20. Levine JM Critical care management of subarachnoid hemorrhage. Curr Neurol Neurosci Rep. 2008; 8: 518-25.
21. 21. Werf DJMVD, Dreisdden R, Hageman L, Velis D, Schievink W, Albercht K, Gent OCV Management of subarachnoid hemorrhage, in Suziki (ed). Advences in Surgery for Cerebral Stroke, Tokyo, Springer- Verlag, 1988, pp 399-404.
22. 22. Baumann F, Khan N. Patient and aneurysm characteristics in multiple intracranial aneurysms. Acta Neurochir Suppl. 2008; 103: 1928.
23. 23. Chyatte D, Fode NC, Sundt TM Jr. Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage. J Neurosurg. 1988; 69: 326-31.
24. 24. Gilsbach JM, Reulen HJ, Ljunggren B. et al. Early aneurysm surgery and preventive therapy with intravenously administered ni-modipine: a multicenter, double-blind, dosecomparison study. Neurosurgery. 1990; 26: 458-64.
25. 25. Adams HP Jr, Kassell NF, Tomer JC, Nib-belink DW, Sahs AL. Early management of aneurysmal subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. J Neurosurg. 1981 ;54: 141-5.
26. 26. Kassell NF, Tomer JC, Jane JA, Haley EC Jr, Adams HP. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg. 1990; 73: 37-47.
27. 27. Seiler RW, Reulen HJ, Huber P, Grolimund P, Ebeling U, Steiger HJ. Outcome of aneurysmal subarachnoid hemorrhage in a hospital population: a prospective study including early operation, intravenous nimodipine, and transcranial Doppler ultrasound. Neurosurgery. 1988; 23: 598-604.
28. 28. Nieuwkamp DJ, de Gans K, Algra A, et al. Timing of aneurysm surgery in subarachnoid haemorrhage--an observational study in The Netherlands. Acta Neurochir (Wien). 2005:147: 815-21.
29. 29. Lakicevic NP, Gore KC. Early surgery of hemorrhaging aneurysms of brain blood vessels. Acta Chir lugosl. 2008; 55: 17-25.
30. 30. Ross N, Hutchinson PJ, Seeley H, Kirckpat-rick PJ. Timing of surgery for supratentorial aneurysmal subarachnoid haemorrhage: report of a prospective study. J Neurol Neurosurg Psychiatry. 2002; 72: 480-4.
31. 31. Auer LM. Management of patients with ruptured cerebral aneurysms, in Susiki J (ed): Advances in Surgery for Cerebral Stroke. Tokyo, Springer-verlag, 1988, pp 317-322
32. 32. Bailes JE, Spetzler RF, Hadley MN, Baldwin HZ. Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg. 1990; 72: 559-66.
33. 33. Sengupta RP. Indications and timing of surgery on ruptured intacranial aneurysms, in Suziki (ed).Advences in Surgery for Cerebral Stroke, Tokyo, Springer _Verlag, 1988, pp 311-316.
34. 34. Hauck EF, Welch BG, White JA, et al. StenV coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms. Surg Neurol. 2009; 71: 19-24.
35. 35. van Rooij WJ, Sluzewski M, Beute GN, Nijs-sen PC. Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol. 2006; 27: 1498-501.