Kraniostomija sa drenažom u lokalnoj anesteziji i sedećem položaju za lečenje hroničnog subduralnog hematoma
Sažetak
Uvod/Cilj. Hronični subduralni hematom (HSH) je jedan od najčešćih neurohiruršklih entiteta sa ukupnom incidencom javljanja od 1,72 do 20,6 na 100 000 osoba godišnje. Hirurška procedura za lečenje HSH je relativno jednostavna i obično se izvodi u ležećem položaju. Stopa recidiva iznosi od 11,7% do 28%. Postoperativni pneumocefalus se smatra nezavisnim pojedinačnim prediktorom recidiva. Cilj rada bio je da se proceni prednost procedure u sedećem položaju u lečenju bolesnika sa HSH, kao i njen eventualnim uticaj na stopu recidiva. Metode. Studija je obuhvatila 31 bolesnika kojima je urađena kraniostomija sa zatvorenim sistemom za drenažu HSH pod lokalnom anestezijom (16 u ležećem položaju na leđima i 15 u sedećem položaju), u periodu od decembra 2016. do maja 2018. godine. Rezultati. Studijom su obuhvaćena 22 muškarca i 9 žena. Ukupna stopa recidiva iznosila je 19% (22% kod žena i 18% kod muškaraca). Recidiv se javio kod 5 operisanih u ležećem položaju i kod samo jedne bolesnice operisane u sedećem položaju. Naši rezultati su pokazali trend ređe pojave recidiva kod bolesnika operisanih u sedećem položaju, iako razlika nije bila statistički značajna [odds ratio (OR): 0.18; 95% interval poverenja: 0.01–1.42, p = 0.172]. Zaključak. Kraniostomija u sedećem položaju pod lokalnom anestezijom je sigurna, jednostavna i pouzdana procedura za lečenje HSH. Pored toga što je veoma komforna za bolesnika, prema našim inicijalnim rezultatima, mogla bi da vodi i sniženju stope recidiva, verovatno zahvaljujući boljoj kontroli ulaska vazduha i pojave posledičnog pneumocefalusa.
Reference
Sahyouni R, Goshtasbi K, Mahmoodi A, Tran DK, Chen JW. Chronic Subdural Hematoma: A Historical and Clinical Per-spective. World Neurosurg 2017; 108: 948‒53.
Yang W, Huang J. Chronic Subdural Hematoma: Epidemiology and Natural History. Neurosurg Clin N Am 2017; 28(2): 205‒10.
Montano N, Stifano V, Skrap B, Mazzucchi E. Management of residual subdural hematoma after burr-hole evacuation. The role of fluid therapy and review of the literature. J Clin Neu-rosci 2017; 46: 26‒9.
Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haemato-ma: inflammation, angiogenesis and implications for pharma-cotherapy. J Neuroinflammation 2017; 14(1): 108.
Novaković N, Lepić M, Minić L, Radenović K, Rotim A, Rasulić L. Combined Treatment of Ruptured Middle Cerebral Artery Aneurysm Followed by Subarachnoid Hemorrhage and Acute Subdural Hematoma in Multiple Aneurysm Disease of Cere-bral Blood Vessels: Case Report. Acta Clin Croat 2016; 55(4): 659‒62.
Welling LC, Welling MS, Teixeira MJ, Figueiredo EG. Chronic Subdural Hematoma: So Common and So Neglected. World Neurosurg 2018; 111: 393‒4.
Liu W, Bakker NA, Groen RJ. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg 2014; 121(3): 665‒73.
Winn HR. Youmans and Winn Neurological Surgery E-Book. 7th ed. Philadelphia, PA: Elsevier; 2016.
Buchanan IA, Mack WJ. Minimally Invasive Surgical Approach-es for Chronic Subdural Hematomas. Neurosurg Clin N Am 2017; 28(2): 219‒27.
Rasulić L, Lepić M. Neurosurgical clinical practice guidelines and recommendations: Experience, Evidence and Enrich-ment. World Neurosurg 2019; 26: 76‒8.
Mori K, Maeda M. Surgical treatment of chronic subdural he-matoma in 500 consecutive cases: clinical characteristics, sur-gical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 2001; 41(8): 371‒81.
You C G, Zheng XS. Postoperative pneumocephalus increases the recurrence rate of chronic subdural hematoma. Clin Neu-rol Neurosurg 2018; 166: 56‒60.
Himes BT, Mallory GW, Abcejo AS, Pasternak J, Atkinson JLD, Meyer FB, et al. Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position. J Neurosurg 2017; 127(1): 182‒8.
Ammirati M, Lamki TT, Shaw AB, Forde B, Nakano I, Mani M. A streamlined protocol for the use of the semi-sitting position in neurosurgery: a report on 48 consecutive procedures. J Clin Neurosci 2013; 20(1): 32‒4.
Jadik S, Wissing H, Friedrich K, Beck J, Seifert V, Raabe A. A standardized protocol for the prevention of clinically relevant venous air embolism during neurosurgical interventions in the semisitting position. Neurosurgery 2009; 64(3): 533‒8; discus-sion 8‒9.
R Core Team (2018). R: A language and environment for sta-tistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available online at https://www.R-project.org/.
Subirana I, Sanz H, Vila J. Building Bivariate Tables: The compareGroups Package for R. J Statistical Software 2014; 57(12): 1‒16.
Wickham H. Ggplot2 Elegant Graphics for Data Analysis. 2nd ed. New York: Springer; 2009.
Kanyi JK, Ogada TV, Oloo MJ, Parker RK. Burr-Hole Crani-ostomy for Chronic Subdural Hematomas by General Sur-geons in Rural Kenya. World J Surg 2018; 42(1): 40‒5.
Desai VR, Scranton RA, Britz GW. Management of Recurrent Subdural Hematomas. Neurosurg Clin N Am 2017; 28(2): 279‒86.
Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yama-gata S. Independent predictors for recurrence of chronic sub-dural hematoma: a review of 343 consecutive surgical cases. Neurosurgery 2008; 63(6): 1125‒9; discussion 1129.
Abouzari M, Rashidi A, Rezaii J, Esfandiari K, Asadollahi M, Aleali H, et al. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery. Neurosurgery 2007; 61(4): 794-7; discus-sion 797.
Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2012; 154(9): 1541‒8.
Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S. Independent predictors of recurrence of chronic sub-dural hematoma: results of multivariate analysis performed us-ing a logistic regression model. J Neurosurg 2003; 98(6): 1217‒21.
Kamenova M, Lutz K, Schaedelin S, Fandino J, Mariani L, Soleman J. Does Early Resumption of Low-Dose Aspirin After Evacu-ation of Chronic Subdural Hematoma With Burr-Hole Drain-age Lead to Higher Recurrence Rates? Neurosurgery 2016; 79(5): 715‒21.
Kwon CS, Al-Awar O, Richards O, Izu A, Lengvenis G. Predict-ing Prognosis of Patients with Chronic Subdural Hematoma: A New Scoring System. World Neurosurg 2018; 109: e707‒e14.
Stanisić M, Pripp H. A Reliable Grading System for Prediction of Chronic Subdural Hematoma Recurrence Requiring Re-operation After Initial Burr-Hole Surgery. Neurosurgery 2017; 81(5): 752‒60.
Wang QP, Yuan Y, Guan JW, Jiang XB. A comparative study of irrigation versus no irrigation during burr hole craniostomy to treat chronic subdural hematoma. BMC Surg 2017; 17(1): 99.
Wang W, Liu H, Yang J. Burr hole craniostomy irrigation with and without drainage during surgical treatment of chronic subdural hematoma: A retrospective study of 87 cases. Turk Neurosurg 2017; doi: 10.5137/1019-5149.JTN.19747-16.2.
Ganslandt O, Merkel A, Schmitt H, Tzabazis A, Buchfelder M, Eyupoglu I, et al. The sitting position in neurosurgery: indica-tions, complications and results. a single institution experience of 600 cases. Acta Neurochir (Wien) 2013; 155(10): 1887‒93.