Subduroperitoneal şant komplikasyonları
Küçük Resim Yok
Tarih
1999
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
ÖZET: Subdural kolleksiyonlar, kronik subdural hematom ve subdural effüzyon olarak anılan kanlı ve ksantokromik sıvılardır. Genellikle bebeklerde görülmekle birlikte erkek dominansı belirgindir. Subdural ponksiyon, kranyotomi ve membranlarm çıkarılması ve subdural mesafenin şantlanması infantil kronik subdural hematomların tedavisinde kullanılan yöntemlerdir. Subdural kolleksiyonlarm tedavisinde belirgin bir görüş birliği yoktur. Çalışmaya dahil olan subduroperitoneal şant yerleştirilmiş subdural kolleksiyonlu 97 hastanın sonuçlan incelenmiştir. Bütün hastalarda subdural kolleksiyon tanısı BBT veya MRG ile konulmuştur. Bu çalışmaya yaşlan 1 ile 180 ay arasında değişen 73 erkek ve 24 kız olgu dahil edilmiştir. Hastalann yüzde 93 'ü 2 yaş altındadır. Hastalann 40'mda kolleksiyon menenjit sonrasında ortaya çıkarken, 23 olguda kafa travmasını takiben gözlenmiştir. En sık gözlenen semptom nöbetlerdi (44 hasta). Subdural sıvı kolleksiyonlannın 75 'i bilateral iken 22 'sinde unilateral olduğu görüldü. Hastalann subdural sıvı kolleksiyonlan bilateral olsa dahi unilateral şantlama yapıldı. 16 olguda 20 şant revizyonuna ihtiyaç duyuldu. En sık karşılaşılan komplikasyon şant obstrüksiyonu idi (13 hasta). Migrasyon şant pompası veya rezervuar kullanılan hastalarda hiç görülmezken bu hastalann 4'ünde deri nekrozlan ile karşılaşıldı. Hastalanmızın %4'ünde şant enfeksiyonu görüldü. Bir hastada barsak perforasyonunu takiben subdural ampiyem gelişti. Tedavi sonunda 70 hastanın şantı çıkanldı. 3 hasta ölüm nedeni subdural sıvı kolleksiyonu olmamasına rağmen kaybedildi. 59 hastada mükemmel sonuç elde edilirken, 22 olguda modere defisit görüldü. Sonuç olarak subdural kolleksiyon bilateral olsa dahi unilateral şantlama genellikle effektif sonuç verir. Küçük rezervuar kullanımı migrasyonu engeller. Şant çıkanlması sırasında kateterin subdural mesafede yapışık olduğu gözlendiğinde bırakılması gelişebilecek yeni komplikasyonlan önleyecektir. Subduroperitoneal şantlama çocuklarda semptomatik subdural sıvı kolleksiyonlannın tedavisinde effektif bir yöntemdir. 17
ABSTRACT: Subdural collections comprise chronic subdural hematomas and subdural effusions which consist of bloody and xanthochromic fluid. They are frequently seen in infants and there is male preponderance. Subdural tapping, craniotomy and removal of membranes, and shunting from the subdural space have been used in the treatment of infantile chronic subdural hematomas. There is no consensus on the management of infantile chronic subdural collections. The results of 97 consecutive patients in which a subdural-peritoneal shunt was inserted for the treatment of subdural collection are presented. Subdural fluid collection was diagnosed with computed tomography or magnetic resonance imaging in all patients. There were 73 boys and 24 girls who ranged in age from 1 to 180 months. Ninety-three percent of the patients were under the age of 2 years. Subdural effusions following meningitis were present in 40 patients and head injury led to subdural collection in 23 in pur patients. Subdural fluid collection was bilateral in 75 and unilateral in 22 patients. The most common presenting symptom was seizure (44 patients). Unilateral S/P shunts were inserted in all patients with bilateral subdural collections. 20 shunt revisions were done in 16 patients. The most common complication was shunt obstruction (13 patients). Migration was never encountered in the shunt containing a flushing valve or reservoir. However, they led to skin necrosis in 4 patient. In 4% of our patients, S/P shunt infection occurred. In one of patients, subdural empyema developed following bowel perforation. S/P shunts were removed in 70 cases. 3 patients died. In none of the deaths, the cause was subdural fluid collection. The outcome was excellent in 59 patient, moderate deficits were present in 22 patients. Unilateral S/P shunting is usually effective in bilateral subdural fluid collections. Tubing with a small reservoir will prevent shunt migrations. If the catheter is stuck in the subdural space, it should be left in place not to cause complications during shunt removal. S/P shunting is the effective mode of treatment in the management of symptomatic subdural fluid collections in children. ^m^müM KÜRUIS mim Mwm u19202122
ABSTRACT: Subdural collections comprise chronic subdural hematomas and subdural effusions which consist of bloody and xanthochromic fluid. They are frequently seen in infants and there is male preponderance. Subdural tapping, craniotomy and removal of membranes, and shunting from the subdural space have been used in the treatment of infantile chronic subdural hematomas. There is no consensus on the management of infantile chronic subdural collections. The results of 97 consecutive patients in which a subdural-peritoneal shunt was inserted for the treatment of subdural collection are presented. Subdural fluid collection was diagnosed with computed tomography or magnetic resonance imaging in all patients. There were 73 boys and 24 girls who ranged in age from 1 to 180 months. Ninety-three percent of the patients were under the age of 2 years. Subdural effusions following meningitis were present in 40 patients and head injury led to subdural collection in 23 in pur patients. Subdural fluid collection was bilateral in 75 and unilateral in 22 patients. The most common presenting symptom was seizure (44 patients). Unilateral S/P shunts were inserted in all patients with bilateral subdural collections. 20 shunt revisions were done in 16 patients. The most common complication was shunt obstruction (13 patients). Migration was never encountered in the shunt containing a flushing valve or reservoir. However, they led to skin necrosis in 4 patient. In 4% of our patients, S/P shunt infection occurred. In one of patients, subdural empyema developed following bowel perforation. S/P shunts were removed in 70 cases. 3 patients died. In none of the deaths, the cause was subdural fluid collection. The outcome was excellent in 59 patient, moderate deficits were present in 22 patients. Unilateral S/P shunting is usually effective in bilateral subdural fluid collections. Tubing with a small reservoir will prevent shunt migrations. If the catheter is stuck in the subdural space, it should be left in place not to cause complications during shunt removal. S/P shunting is the effective mode of treatment in the management of symptomatic subdural fluid collections in children. ^m^müM KÜRUIS mim Mwm u19202122
Açıklama
Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.
Anahtar Kelimeler
Nöroşirürji, Neurosurgery, Subdural mesafe, Subdural space
