Ventriküloperitoneal şant cerrahisi uygulanan pediatrik hidrosefali olgularının retrospektif değerlendirilmesi
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Tarih
2022
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
VENTRİKÜLOPERİTONEAL ŞANT CERRAHİSİ UYGULANAN PEDİATRİK HİDROSEFALİ OLGULARININ RETROSPEKTİF DEĞERLENDİRİLMESİ LOKMAN AYHAN UZMANLIK TEZİ KONYA, 2022 Amaç: Bu çalışmada ventriküloperitoneal şant cerrahisi uygulanan pediatrik hidrosefali olguları retrospektif olarak değerlendirildi. Yöntem ve Gereç: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Nöroşirürji Anabilim Dalında Ocak 2009 - Aralık 2020 tarihleri arasında hidrosefali tanısı ile ventriküloperitoneal şant uygulanan, verileri eksiksiz 112 pediatrik olgu retrospektif olarak değerlendirildi. Olgular; demografik özellikleri, hidrosefali tanı yöntemi, Evans indeksi, hidrosefali etiyolojisi, ventriküloperitoneal şant tipi, ventriküloperitoneal şant cerrahisi komplikasyonları, revizyon cerrahisi sayısı ve nedeni ile ilk revizyon cerrahisi zamanı açısından literatür bilgileri eşliğinde incelendi. Kategorik verilerin karşılaştırılmasında, Ki-kare (ꭕ2) testi ve Fisher Exact testi kullanıldı. Anlamlılık p<0,05 düzeyinde değerlendirildi. Bulgular: Çalışmamızdaki olguların %60,7'si (n=68) erkek, %39,3'ü (n=44) kız idi. Araştırmaya alınan hastaların %57,1'i (n=64) 2-12 yaş arasında çocuk, %27,7'si (n=31) 0-2 yaş arası bebek, %15,2'si (n=17) 12-18 yaş arasında adölesan idi. Hastaların %66,1'i (n=74) miadında doğmuştu. Çalışmaya dahil edilen hastaların Evans İndeks ortalaması 0,54±0,11 olarak bulundu. En sık görülen etiyolojik neden konjenital hidrosefaliydi. Hastalara %80,4 (n=90) oranında sabit basınçlı şant, %19,6 (n=22) oranında programlanabilir şant tipi kullanıldı. Opere edilen hastaların %50'sinde (n=56) komplikasyon gelişirken, en sık komplikasyonlar ventriküler uç tıkanıklığı ve şant enfeksiyonuydu. Ventriküloperitoneal şant takılan 53 olguda revizyon cerrahisi gereksinimi ortaya çıktı. Hastalara uygulanan revizyon cerrahi sayısı ortancası 1,00 (min=1,00, max=4,00) olarak saptandı. Çalışmaya dahil edilen hastalarda cinsiyete ve yaşa göre; etiyolojide, hastalara uygulanan ventriküloperitoneal şant tipinde, şant komplikasyonunda ve oluşan komplikasyonların tipinde anlamlı fark tespit edilmedi. Revizyon cerrahisi yapılan hastaların yaş grupları karşılaştırıldığında, adölesan yaş grubundaki hastaların revizyon operasyonu geçirme oranları diğer yaş gruplarına göre istatistiksel olarak anlamlı düşüktü. Revizyon operasyonu geçiren hastaların Evans indeksleri istatistiksel olarak anlamlı düşüktü. Hastaların 1 yada 2 ve üzeri sayıda revizyon cerrahisi geçirmeleri ile revizyon cerrahisi nedenleri arasında istatistiksel olarak anlamlı fark bulunmadı. İlk revizyon süresi 0-6 ay olan grupta en fazla oranda enfektif komplikasyonlar nedeni ile revizyon görülürken, 6 ay ve üzeri olan grupta en fazla mekanik komplikasyonlara bağlı revizyon görüldü. Sonuç: Günümüzde halen ventriküloperitoneal şant cerrahisi pediatrik hidrosefali olgularında en fazla tercih edilen ve en etkin tedavi yöntemidir. Ventriküloperitoneal şant cerrahisi uygulanması ve takibinde gerekli özenin gösterilmesinin tedavide başarı oranını olumlu yönde etkileyeceği kanaatindeyiz. Anahtar sözcükler: Hidrosefali, pediatrik, ventriküloperitoneal şant
RETROSPECTIVE EVALUATION OF PEDIATRIC HYDROCEPHALUS CASES WHO UNDERWENT VENTRICULOPERITONEAL SHUNT SURGERY LOKMAN AYHAN SPECİALİST THESIS KONYA, 2022 Objective: In this study, pediatric hydrocephalus cases who underwent ventriculoperitoneal shunt surgery were evaluated retrospectively. Material and Method: One hundred and twelve pediatric cases with complete data, who underwent ventriculoperitoneal shunt surgery with the diagnosis of hydrocephalus between January 2009 and December 2020 in Neurosurgery Department of Necmettin Erbakan University, Meram Faculty of Medicine were evaluated retrospectively. The cases were evaluated according to; demographic characteristics, hydrocephalus diagnosis method, Evans index, hydrocephalus etiology, ventriculoperitoneal shunt type, complications of ventriculoperitoneal shunt surgery, number and reason of revision surgery and time of the first revision surgery. The results discussed in the light of relevant literature. Chi-square (ꭕ2) test and Fisher Exact test were used to compare categorical data. Significance was evaluated at the p<0.05 level. Findings: In this study, 60,7% (n=68) of the cases were male while 39,3% (n=44) of them were female. Of the patients included in the study, 57,1% (n=64) were children aged 2-12 years, 27,7% (n=31) were infants aged 0-2 years, and 15,2% (n=17) were adolescents aged 12-18 years. 66.1% (n=74) of the patients were born at term. The mean Evans Index of the patients included in the study was 0,54±0,11. The most common etiological cause was congenital hydrocephalus. Fixed pressure shunt was used in 80,4% (n=90) and programmable shunt type was used in 19,6% (n=22) of the patients. Complications developed in 50% (n=56) of the operated patients, with the most common complications being ventricular tip obstruction and shunt infection. Revision was required in 53 patients with ventriculoperitoneal shunt placement. The median of the revision surgeries to patient was identified as 1.00 (min=1.00, max=4.00) No significant difference was found in the type of ventriculoperitoneal shunt in the etiology and type of complications regarding gender and age in the patients included in the study. Comparing the age groups of the patients underwent revision surgery, the rate of revision surgery in the adolescent age group was found to be statistically significantly lower than the other age groups. Evans Index of patients underwent revision operations were found to be statistically significantly lower. There was no statistically significant difference between the patients underwent 1 or 2 or more revision surgeries and the reasons for revision surgery. While revision due to infective complications was observed in the group with the first revision period of 0-6 months, revision due to mechanical complications was observed in the group with a duration of 6 months or more. Results: Today, ventriculoperitoneal shunt surgery is still the most preferred and effective treatment method in pediatric hydrocephalus cases. According to our opinion taking care during application and follow-up will positively affect the success rate of the treatment. Keywords: Hydrocephalus, pediatric, ventriculoperitoneal shunt
RETROSPECTIVE EVALUATION OF PEDIATRIC HYDROCEPHALUS CASES WHO UNDERWENT VENTRICULOPERITONEAL SHUNT SURGERY LOKMAN AYHAN SPECİALİST THESIS KONYA, 2022 Objective: In this study, pediatric hydrocephalus cases who underwent ventriculoperitoneal shunt surgery were evaluated retrospectively. Material and Method: One hundred and twelve pediatric cases with complete data, who underwent ventriculoperitoneal shunt surgery with the diagnosis of hydrocephalus between January 2009 and December 2020 in Neurosurgery Department of Necmettin Erbakan University, Meram Faculty of Medicine were evaluated retrospectively. The cases were evaluated according to; demographic characteristics, hydrocephalus diagnosis method, Evans index, hydrocephalus etiology, ventriculoperitoneal shunt type, complications of ventriculoperitoneal shunt surgery, number and reason of revision surgery and time of the first revision surgery. The results discussed in the light of relevant literature. Chi-square (ꭕ2) test and Fisher Exact test were used to compare categorical data. Significance was evaluated at the p<0.05 level. Findings: In this study, 60,7% (n=68) of the cases were male while 39,3% (n=44) of them were female. Of the patients included in the study, 57,1% (n=64) were children aged 2-12 years, 27,7% (n=31) were infants aged 0-2 years, and 15,2% (n=17) were adolescents aged 12-18 years. 66.1% (n=74) of the patients were born at term. The mean Evans Index of the patients included in the study was 0,54±0,11. The most common etiological cause was congenital hydrocephalus. Fixed pressure shunt was used in 80,4% (n=90) and programmable shunt type was used in 19,6% (n=22) of the patients. Complications developed in 50% (n=56) of the operated patients, with the most common complications being ventricular tip obstruction and shunt infection. Revision was required in 53 patients with ventriculoperitoneal shunt placement. The median of the revision surgeries to patient was identified as 1.00 (min=1.00, max=4.00) No significant difference was found in the type of ventriculoperitoneal shunt in the etiology and type of complications regarding gender and age in the patients included in the study. Comparing the age groups of the patients underwent revision surgery, the rate of revision surgery in the adolescent age group was found to be statistically significantly lower than the other age groups. Evans Index of patients underwent revision operations were found to be statistically significantly lower. There was no statistically significant difference between the patients underwent 1 or 2 or more revision surgeries and the reasons for revision surgery. While revision due to infective complications was observed in the group with the first revision period of 0-6 months, revision due to mechanical complications was observed in the group with a duration of 6 months or more. Results: Today, ventriculoperitoneal shunt surgery is still the most preferred and effective treatment method in pediatric hydrocephalus cases. According to our opinion taking care during application and follow-up will positively affect the success rate of the treatment. Keywords: Hydrocephalus, pediatric, ventriculoperitoneal shunt
Açıklama
Anahtar Kelimeler
Hidrosefali, Pediatrik, Ventriküloperitoneal şant, Hydrocephalus, Pediatric, Ventriculoperitoneal shunt
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Künye
Ayhan, L. (2022). Ventriküloperitoneal şant cerrahisi uygulanan pediatrik hidrosefali olgularının retrospektif değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Beyin ve Sinir Cerrahisi Anabilim Dalı, Konya.
