Travmatik beyin hasarýnda erken dekompresif kraniyektominin yeri: Klinik deneyimimiz

AMAÇ: Travmatik beyin hasarý özellikle geri kalmýþ ve geliþmekte olan ülkelerde önemli bir mortalite nedenidir. Serebral dokunun etkilenmesi etkilenmesi nedeniyle, kafa içi basýnç artýþý ve yaygýn ödem sonucu ciddi nörolojik disfonksiyonlarla kendini gösteren bu tabloda, dekompresif krani-yektomi cerrahi tedavi modalitesi olarak kullanýlmaktadýr. Bu çalýþmanýn amacý, travmatik beyin hasarý nedeniyle kliniðimize baþvuran ve dekompresif kraniyektomi yapýlan olgularýn ameliyat sonrasý mortalite ve morbidite oranlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Farklý nedenlere baðlý olarak travmatik beyin hasarý geliþen 57 olgu incelendi. Olgularýn 25’i (%43.8) kadýn, 32’si (%56.1) erkek’ti. Olgularda ortalama yaþ 54.5’di (1–82). Olgularýn 14’ü (%24.5) subdural hematom, beþi (%8.7) epidural hematom, 18’i (%31.5) intrasereb-ral hematom, 13’ü (% 22.8) subaraknoid kanama ve yedisi (%2.2) de tanýmlanamayan radyolojik bulgular ile baþvurmuþtu.
BULGULAR: Elli yedi olgunun tamamýna baþvuru sonrasý en kýsa sürede dekompresif kraniyektomi yapýldý. Ameliyat sonrasý ilk üç günde 12 (%21.1), ameliyat sonrasý 3–15. günler arasýnda ise yedi (%12.2) hasta ilerleyici serebral hasar ve sekonder enfeksiyonlar nedeniyle kaybedildi. Altý (%10.5) olgu tamamen iyileþerek taburcu edildi. Ýyileþen olgularýn 32’si (%56.1) palyatif bakým klinikleri ve fizik tedavi kliniklerine nakil edildi.
TARTIÞMA: Travmatik beyin hasarýnýn tedavisinde hastanýn baþvuru anýndaki nörolojik durumunun iyiliði ve intraserebral etkilenme derecesinin yanýsýra erken dönemde yapýlan dekompresif kraniyektominin etkinliði yüksektir. Daha erken süreçte dekompresif kraniektomi yapýlan olgularda ameliyat sonrasý sonuçlar daha yüz güldürücüdür.

Role of early decompressive craniectomy in traumatic brain injury: Our clinical experience

BACKGROUND: Traumatic brain injury (TBI) is an important cause of death, especially in underdeveloped and developing countries. Diffuse edema in the damaged cerebral tissue as a result of trauma and the subsequent increase in intracranial pressure cause signifi-cant neurological deterioration. Consequently, decompressive craniectomy (DC) is performed as the surgical treatment of TBI. The aim of this study is to evaluate the post-operative mortality and morbidity rates of patients who underwent DC for TBI in our clinic.
METHODS: The data of 57 cases of TBI were retrospectively analyzed. Clinical, radiological and surgical features of these cases were reviewed. The rates of mortality and morbidity, as well as main indicators of mortality were investigated.
RESULTS: Twenty-five (43.8%) patients were female and 32 (56.1%) were male. The mean age was 54.5 years. Fourteen (24.5%) patients were presented with subdural hematoma, 5 (8.7%) with epidural hematoma, 18 (31.5%) with intracerebral hematoma, 13 (22.8%) with subarachnoid hemorrhage, and 7 (12.2%) with other radiological findings. DC was performed in all cases as soon as pos-sible after admission. Twelve (21.1%) patients died in the first 3 days postoperatively and 7 (12.2%) patients in the postoperative 3-15 days due to progressive cerebral damage and secondary infections. Six (10.5%) patients recovered completely and were discharged. Thirty-two (56.1%) patients were transferred to palliative care clinics and physical therapy clinics after the surgical treatment.
CONCLUSION: DC, which is performed in the early period of treatment in TBI, is as important as the degree of intracerebral damage at the time of admission and the high Glasgow coma scale score. Post-operative results are more satisfactory in patients who underwent DC at an earlier stage of treatment.