Ulus Travma Acil Cerrahi Derg. 2015; 21(6): 450-456 | DOI: 10.5505/tjtes.2015.93236

Ýliþkili lezyonlarla birlikte olan travmatik beyin omurilik sývýsý kaçaklarýnýn cerrahi tedavisi

Fatih Alagoz¹, Ergun Daglýoglu¹, Murat Korkmaz², Ali Erdem Yýldýrým¹, Ozhan Merzuk Uckun³, Denizhan Divanlýoglu¹, Omer Polat⁴, Ali Dalgýç¹, Arif Osun², Fevzi Yýlmaz⁵, Muge Sonmez⁵, Ahmet Deniz Belen^1
1Ankara Numune Eðitim Ve Araþtýrma Hastanesi, Beyin Cerrahisi Kliniði, Ankara
²Kütahya Evliya Çelebi Eðitim Ve Araþtýrma Hastanesi, Beyin Cerrahisi Kliniði, Kütahya
³Yunus Emre Devlet Hastanesi, Beyin Cerrahisi Kliniði, Eskiþehir
⁴Özel Fatma Hatun Hastanesi, Beyin Cerrahisi Kliniði, Bolu
⁵Ankara Numune Eðitim Ve Araþtýrma Hastanesi, Acil Kliniði, Ankara

AMAÇ: Kafa travmasý beyin omurilik sývýsý (BOS) fistülü ile önemli bir iliþki gösterir.
GEREÇ VE YÖNTEM: Bu çalýþmada travmaya baðlý geliþen otore, rinore ve oküloresi bulunan 22 hastanýnýn cerrahi yaklaþýmý sunuldu. Hastalarýn büyük çoðunluðu Glaskow Koma Skalasý (GKS) 14 puanýn altýnda olan þiddetli kafa travmalý hastalardýr. Bu hastalarýn 11’inde depresyon fraktürü, altýsýnda epidural hematom ve dördünde ise basýnçlý pnemosefalus eþlik etmekteydi.
BULGULAR: Rinore, en sýk görülen semptom olup 15 hastada, otore yedi hastada ve okülore iki hastada saptandý. Rinoresi olan iki hastada ayrýca otore ve okülore de mevcuttu. On iki hasta tek taraflý yaklaþýmla, 10 hasta ise bifrontal yaklaþýmla opere edildi.
TARTIÞMA: Beyin omurilik sývýsý kaçaðý ile prezente olan travma olgularýnda, konservatif tedavinin aksine yapýlan erken cerrahi giriþimler BOS kaçaðýna baðlý geliþebilecek komplikasyonlarýn engellenmesinde son derece etkili bir yöntemdir.

Anahtar Kelimeler: BOS kaçaðý, cerrahi; okülore; otore; rinore; travma.

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Surgical management of traumatic cerebrospinal fluid fistulas with associated lesions

Fatih Alagoz¹, Ergun Daglýoglu¹, Murat Korkmaz², Ali Erdem Yýldýrým¹, Ozhan Merzuk Uckun³, Denizhan Divanlýoglu¹, Omer Polat⁴, Ali Dalgýç¹, Arif Osun², Fevzi Yýlmaz⁵, Muge Sonmez⁵, Ahmet Deniz Belen^1
1Department Of Neurosurgery, Ankara Numune Training And Research Hospital, Ankara
²Department Of Neurosurgery, Kutahya Evliya Celebi Training And Research Hospital, Kutahya
³Department Of Neurosurgery, Yunus Emre State Hospital, Eskisehir
⁴Department Of Neurosurgery, Fatma Hatun Private Hostpital, Bolu
⁵Department Of Emergency, Ankara Numune Training And Research Hospital, Ankara

BACKGROUND: Head trauma is associated with a significant risk of cerebrospinal fluid (CSF) fistula.
METHODS: In this study, it was aimed to report twenty-two cases subjected to operative intervention for otorrhea, rhinorrhea and oculorrhea with associated traumatic lesions. Majority of the cases had moderate to severe head trauma with a Glascow Coma Scale (GCS) score under 14. The study group included eleven cases with depression fractures, 6 with epidural hematomas and 4 with tension pneumocephalus.
RESULTS: Rhinorrhea was the most common presenting symptom encountered in fifteen cases; whereas, otorrhea was prominent in 7 and oculorrhea in 2 cases. Two patients having rhinorrhea also had oculorrhea and otorrhea. The patients were operated with unilateral approaches in twelve and bifrontal approaches in ten of the cases.
CONCLUSION: Early surgical intervention should be performed in cases presenting with CSF fistula and associated traumatic lesions without considering conservative management to provide an effective control of associated complications due to CSF fistulas.

Keywords: CSF fistula, oculorrhea; otorrhea; rhinorrhea; surgery; trauma.

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