Ulus Travma Acil Cerrahi Derg. 2012; 18(3): 231-238 | DOI: 10.5505/tjtes.2012.79059

Aðýr travmatik beyin yaralanmasý ve bilateral reaktif olmayan pupil dilatasyonu bulunan hastalarda dekompresif cerrahinin etkileri

Ethem Göksu¹, Tanju Uçar¹, Mahmut Akyüz¹, Murat Yýlmaz², Saim Kazan^1
1Nöroþirurji Anabilim Dalý, Akdeniz Üniversitesi Týp Fakültesi, Antalya, Türkiye
²Anesteziyoloji ve Reanimasyon Anabilim Dalý, Akdeniz Üniversitesi Týp Fakültesi, Antalya, Türkiye

AMAÇ
Aðýr travmatik beyin yaralanmalý (ATBY) ve bilateral reaktif olmayan pupil dilatasyonu (BRPD) olup, dekompresif cerrahi (DC) uygulanmýþ hastalarda Glasgow koma skalasý (GKS), kafa içi basýnç (KÝB), serebral perfüzyon basýncý (SPP) deðiþiklikleri ve uzun dönem klinik sonuçlarý deðerlendirildi.
GEREÇ VE YÖNTEM
Çalýþma gurubu, bölümümüzde ATBY nedeniyle DC uygulanan 147 hasta içerisinden BRPD’li 28 hastayý (11 kadýn, 17 erkek) içerdi.
BULGULAR
Ortalama GKS skoru, baþvuruda 4,96±1,20, ameliyat öncesi dönemde 4 idi. Ölen hastalarda, DC sonrasý ortalama KÝB deðerleri hayatta kalanlara göre anlamlý ölçüde yüksekti (p<0,05). Ayrýca, DC sonrasý KÝB azalmasý, yaþayan hastalarda yine anlamlý olarak yüksekti (p<0,05). Tümden mortalite oraný %61,02 bulundu. Baþvuruda ikinin üzeri GKS motor skoru anlamlý olarak düþük mortalite ile iliþkili idi (p<0,05). Yaþayan 4 hasta taburcu sonrasý birinci yýlda (%14,28) iþlevsel sonuç skoru (Glasgow sonuç skoru 4 ve 5) gösterdi.
SONUÇ
ATBY sonrasý BRPD’li hastalarda sonuçlar her zaman ölümcül ya da olumsuz olmayabilir. Hýzlý DC, özellikle baþvuru GKS skoru 6, 7 olan hastalarda iþlevsel saðkalým þansýný artýrabilir.

Anahtar Kelimeler: Dekompresif cerrahi, travmatik beyin yaralanmasý; reaktif olmayan dilate pupil.

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Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils

Ethem Göksu¹, Tanju Uçar¹, Mahmut Akyüz¹, Murat Yýlmaz², Saim Kazan^1
1Department of Neurosurgery, Akdeniz University School of Medicine, Antalya, Turkey
²Department of Anaesthesiology and Intensive Care, Akdeniz University School of Medicine, Antalya, Turkey

BACKGROUND
We investigated Glasgow Coma Scale (GCS) scores, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) changes, and long-term clinical outcomes in patients with severe traumatic brain injury (STBI) associated with bilateral non-reactive dilated pupils (BNDP) who underwent decompressive surgery (DS).
METHODS
The study group consisted of 28 patients (11 females, 17 males) with BNDP from among 147 patients who underwent DS due to STBI in our department.
RESULTS
The mean GCS score was 4.96±1.20 at admission and 4 preoperatively. Mean ICP in non-surviving patients after DS was higher (p<0.05). ICP decrease after DS was also higher in surviving patients than in non-surviving patients (p<0.05). The overall mortality rate was 61.02%. A GCS motor score >2 at admission was associated with lower mortality (p<0.05). Four of the surviving patients (14.28%) had a functional outcome (Glasgow Outcome Score: 4 and 5) at one year after hospital discharge.
CONCLUSION
Outcome in patients with BNDP after STBI may not always be fatal or poor. Rapid DS may increase the chance of functional survival, especially in patients with admission GCS score of 6 or 7.

Keywords: Decompressive surgery, traumatic brain injury; non-reactive dilated pupil.

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