Malign orta serebral arter enfarktlı hastalarda dekompressif cerrahi için risk ve prognostik faktörler
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Dosyalar
Tarih
2016
Yazarlar
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Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/restrictedAccess
Özet
Orta serebral arter (Middle cerebral artery, MCA) tıkanması sonucu gelişen yoğun beyin ödemi ile seyreden ve kliniği kötü seyreden enfarktlara Malign MCA enfarktı denmektedir. Kliniği ağır ve mortalitesi yüksek olan bu hastalarda dekompresyon cerrahisi uzun zamandır kullanılan ve hayat kurtarıcı olabilen bir tedavi yöntemidir.Bu çalışmada dekompressif kraniektomi yapılan malign MCA enfarktlı hastalarda mortalite için risk faktörlerini ve prognostik faktörleri araştırmayı amaçladık.Trakya Üniversitesi Sağlık Araştırma ve Uygulama Merkezi (TUSAM) Nöroşirürji Anabilim Dalında dekompresyon yapılan 53 malign MCA’lı hastanın dosyası retrospektif olarak incelendi. Hastaların %54.7’si erkekti, yaş ortalaması 57.4 ± 12.2 bulundu. Hastaların %56.6’sı 60 yaşından küçüktü.Hastaların %26.4’ü antiagregan kullanmakta, %43.4’ünde aritmi, %60.4’ünde diabetes mellitus, %34’ünde hipertansiyon öyküsü mevcuttu. Hastaların %71.7’sinde MCA’da enfart görülmüş, %49.1’inde sağ hemisfer tutulmuş, %35.9’u ilk 24 saatte cerrahiye alınmıştır. Mortalite %35.8 bulunmuştur. Postoperatuvar değerlendirmede hastalarda GKS’de artış görülmüştür. Hastalardan postop dönemde anizokorisi olmayanlarda, orta hat shifti 0.5 cm’den az olanlarda, erkek hastalarda, ilk 24 saatte cerrahiye alınanlarda daha fazla oranda GKS artışı görüldü.Çalışmamızdan elde edilen sonuçlar malign MCA enfarktı nedeniyle dekompressif kraniektomi uygulanan hastalarda erken cerrahinin faydalı olduğunu; anizokori ve shift bulunmasınınkötü prognozla ilişkili olduğunu düşündürtmektedir.
abstract
Malignant MCA infarction' term refers unfavorable clinical picture following a middle cerebral artery territory stroke and subsequent massive cerebral edema. Decompressive surgery is used for a long time in those patients with unfavorable clinical scenario and high mortality rate and can be life-saving. In this study, we aimed to evaluate the prognostic factors in patients who underwent decompressive craniectomy for malign MCA infarction.53 patients with malign MCA infarction who underwent decompression surgery at the Trakya University Health Research and Practice Center Neurosurgery Department were retrospectively reviewed. 54.7% of patients were male, and the mean age was 57.4±12.2. 56.6% of all patients were younger than 60 years old. 26.4% of patients were on antiagregan treatment, 43.4% had arrithmia, 60.4% had diabetes mellitus, and % had hypertension. 71.7% of patients had MCA infarction, right hemisphere was affected in 49.1% of patients, and 35.9% of patients underwent surgery in the first 24 hours. Mortality rate was 35.8%. Glasgow Coma Scale (GCS) points increased postoperatively. Improvement in the GCS point was more prominent in patients without anisocoria in the postoperative period, with a midline shift less than 0.5cm, in male patients, and in patients underwent surgery in the first 24 hours of infarction. Our results suggest that earlier surgery may be beneficial; and existence of aniscoria and midline shift are related with unfavorable prognosis in patients who underwent decompressive craniectomy for malignant MCA infarction.
abstract
Malignant MCA infarction' term refers unfavorable clinical picture following a middle cerebral artery territory stroke and subsequent massive cerebral edema. Decompressive surgery is used for a long time in those patients with unfavorable clinical scenario and high mortality rate and can be life-saving. In this study, we aimed to evaluate the prognostic factors in patients who underwent decompressive craniectomy for malign MCA infarction.53 patients with malign MCA infarction who underwent decompression surgery at the Trakya University Health Research and Practice Center Neurosurgery Department were retrospectively reviewed. 54.7% of patients were male, and the mean age was 57.4±12.2. 56.6% of all patients were younger than 60 years old. 26.4% of patients were on antiagregan treatment, 43.4% had arrithmia, 60.4% had diabetes mellitus, and % had hypertension. 71.7% of patients had MCA infarction, right hemisphere was affected in 49.1% of patients, and 35.9% of patients underwent surgery in the first 24 hours. Mortality rate was 35.8%. Glasgow Coma Scale (GCS) points increased postoperatively. Improvement in the GCS point was more prominent in patients without anisocoria in the postoperative period, with a midline shift less than 0.5cm, in male patients, and in patients underwent surgery in the first 24 hours of infarction. Our results suggest that earlier surgery may be beneficial; and existence of aniscoria and midline shift are related with unfavorable prognosis in patients who underwent decompressive craniectomy for malignant MCA infarction.
Açıklama
Anahtar Kelimeler
MCA, Enfarktüs, Kraniyotomi, Dekompresyon, Decompression, Infarctus, Craniotomy
