Ekstra-aksiyel Kanamalarda Nöroşirürjik Acil Yönetim
Özet
Bu çalışma, kafa travmaları sonrası sıkça karşılaşılan epidural (EDH) ve subdural hematomların (SDH) epidemiyolojisi, patofizyolojisi, klinik özellikleri ve cerrahi yönetimini kapsamlı bir şekilde ele almaktadır. Ekstra-aksiyel kanamalar genellikle genç erkeklerde motorlu taşıt kazaları nedeniyle görülürken, yaşlı popülasyonda düşmeler ve antikoagülan kullanımı mortalite riskini artırmaktadır. Patofizyolojik açıdan EDH'ler genellikle arteriyel kaynaklı olup kafatası kırıklarıyla ilişkilidir; SDH'ler ise daha çok köprü venlerin yırtılmasıyla oluşur ve kronikleşme eğilimi gösterebilir. Klinik değerlendirmede Glasgow Koma Skoru (GKS) ve pupil muayenesi altın standarttır. Beyin fıtıklaşmaları (herniasyonlar), bu tip kanamalarda en ciddi komplikasyonlardır ve acil müdahale gerektirir. Tanıda kontrastsız beyin BT, hızlı ve güvenilir olması nedeniyle ilk tercihtir. Acil yönetimde hava yolu, solunum ve dolaşım stabilizasyonu (ABC) hayati önem taşırken; kafa içi basıncın kontrolü için medikal ve cerrahi yöntemler kullanılır. Cerrahi kararında hematom hacmi (EDH için >30 ml), kalınlığı ve orta hat kayması gibi radyolojik kriterler ile hastanın nörolojik durumu belirleyici rol oynar. Erken tanı ve zamanında müdahale prognozu doğrudan iyileştirmektedir.
This study comprehensively examines the epidemiology, pathophysiology, clinical features, and surgical management of epidural (EDH) and subdural hematomas (SDH), which are frequently encountered following head trauma. While extra-axial hemorrhages occur more often in young males due to motor vehicle accidents, falls and anticoagulant use in the elderly population increase the risk of mortality. Pathophysiologically, EDHs are generally of arterial origin and associated with skull fractures, whereas SDHs are mostly caused by the rupture of bridging veins and can tend to become chronic. In clinical assessment, the Glasgow Coma Scale (GCS) and pupil examination are the gold standards. Brain herniations are the most serious complications in these types of hemorrhages and require emergency intervention. Non-contrast brain CT is the first choice in diagnosis due to its speed and reliability. In emergency management, stabilization of airway, breathing, and circulation (ABC) is vital, while medical and surgical methods are used to control intracranial pressure. Radiological criteria such as hematoma volume (>30 ml for EDH), thickness, and midline shift, along with the patient's neurological status, play a decisive role in the surgical decision. Early diagnosis and timely intervention directly improve the prognosis.
Referanslar
Coronado VG, Xu L, Basavaraju SV, et al. Surveillance for traumatic brain injury-related deaths--United States, 1997-2007. MMWR Surveill Summ. 2011;60(5):1-32.
Aromatario M, Torsello A, D'Errico S, et al. Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating. Medicina (Kaunas). 2021;57(2).
Yagi T, Suzuki T, Nagata Y, et al. [The cases of acute spontaneous subdural hematoma]. No Shinkei Geka. 1996;24(7):665-669.
Isik HS, Bostanci U, Yildiz O, et al. [Retrospective analysis of 954 adult patients with head injury: an epidemiological study]. Ulus Travma Acil Cerrahi Derg. 2011;17(1):46-50.
Karasu A, Sabanci PA, Cansever T, et al. [Epidemiological study in head injury patients]. Ulus Travma Acil Cerrahi Derg. 2009;15(2):159-163.
Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic Brain Injury: An Overview of Epidemiology, Pathophysiology, and Medical Management. Med Clin North Am. 2020;104(2):213-238.
Mina AA, Knipfer JF, Park DY, et al. Intracranial complications of preinjury anticoagulation in trauma patients with head injury. J Trauma. 2002;53(4):668-672.
Goodman JC. Neuropathology of Traumatic Brain Injury. In: Winn HR, editor. Youmans & Winn Neurological Surgery. 7th2016.
Greenberg MS. Handbook of neurosurgery. Eighth edition. ed. New York: Thieme; 2016. p. p.
Meaney DF, Cullen DK. Biomechanical Basis of Traumatic Brain Injury. In: Winn HR, editor. Youmans & Winn Neurological Surgery. 7th2016.
Shahlaie K, Zwienenberg-Lee M, Muizelaar JP. Clinical Pathophysiology of Traumatic Brain Injury. In: Winn HR, editor. Youmans & Winn Neurological Surgery. 7th2016.
Stein SC, Spettell C. The Head Injury Severity Scale (HISS): a practical classification of closed-head injury. Brain Inj. 1995;9(5):437-444.
Plum F, Posner JB. The diagnosis of stupor and coma. Contemp Neurol Ser. 1972;10:1-286.
Parizel PM, Makkat S, Jorens PG, et al. Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage). Intensive Care Med. 2002;28(1):85-88.
Lobato RD, Rivas JJ, Gomez PA, et al. Head-injured patients who talk and deteriorate into coma. Analysis of 211 cases studied with computerized tomography. J Neurosurg. 1991;75(2):256-261.
Hudgins E, Grady MS. Initial Resuscitation, Prehospital Care, and Emergency Room Care in Traumatic Brain Injury. In: Winn HR, editor. Youmans & Winn Neurological Surgery. 7th2016.
Jain S, Iverson LM. Glasgow Coma Scale. StatPearls. Treasure Island (FL)2021.
Leveille E, Schur S, AlAzri A, et al. Clinical Characterization of Traumatic Acute Interhemispheric Subdural Hematoma. Can J Neurol Sci. 2020;47(4):504-510.
Jin H, Wang S, Hou L, et al. Clinical treatment of traumatic brain injury complicated by cranial nerve injury. Injury. 2010;41(9):918-923.
Sharif-Alhoseini M, Khodadadi H, Chardoli M, et al. Indications for brain computed tomography scan after minor head injury. J Emerg Trauma Shock. 2011;4(4):472-476.
Yuh EL. Structural Imaging of Traumatic Brain Injury. In: Winn HR, editor. Youmans & Winn Neurological Surgery. 7th2016.
Mayglothling J, Duane TM, Gibbs M, et al. Emergency tracheal intubation immediately following traumatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S333-340.
Huang MC. Surgical Management of Traumatic Brain Injury. In: Winn HR, editor. Youmans & Winn Neurological Surgery. 7th2016.
