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Journal of Neurosurgical Sciences 1998 June;42(2):89-94

Copyright © 1998 EDIZIONI MINERVA MEDICA

lingua: Inglese

Is it possible to recover from uncal herniation? Analysis of 71 head injured cases

Uzan M. 1, Yentur E. 2, Hanci M. 1, Kaynar M. Y. 1, Kafadar A. 1, Sarioglu A. C. 1, Bahar M. 2, Kuday C. 1

1 Department of Neurosurgery, Istanbul University, Cerrahpas¸a Medical Faculty, Istanbul, Turkey; 2 Department of Anaesthesiology, Istanbul University, Cerrahpas¸a Medical Faculty, Istanbul, Turkey


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Background. Uncal her­ni­a­tion (UH) ­caused by head trau­ma may ­become a fatal pro­cess if not treat­ed rap­id­ly.
Methods. We ana­lysed the fac­tors affect­ing the out­come in 71 sur­gi­cal­ly treat­ed ­patients who had intra­cra­ni­al hae­mat­o­ma diag­nosed by com­pu­ter­ized tomog­ra­phy (CT), ­between January 1987 and June 1994 with the symp­toms of UH. Age, inci­dent-treat­ment inter­val, Glasgow Coma Scale (GCS), type of the ­lesion and the pres­ence of poly­trau­ma were cor­re­lat­ed with Glasgow Outcome Scales (GOS) using SPSS PC+ sta­tis­ti­cal soft­ware.
Results. 49.3% of our ­patients were ­referred ­because of a fall from a ­height and 46.5% ­because of a motor vehi­cle acci­dent. 12.7% of the ­patients were poly­trau­ma­tized. The mean GCS of the ­series was 5.662. The mean GCS of the ­patients ­expired and who were in good recov­ery state were 4.8 and 6.9 respec­tive­ly. Age, pres­ence of poly­trau­ma, type of the ­lesion and time inter­val ­between the inci­dent and the treat­ment was found to be sta­tis­ti­cal­ly insig­nif­i­cant when cor­re­lat­ed with GOS. The cor­re­la­tion value ­between the GCS val­ues and GOS was found to be high­ly sig­nif­i­cant (p<0.00001).
Conclusions. The find­ings ­showed that the ­degree of the her­ni­a­tion is the most impor­tant fac­tor that ­affects the prog­no­sis of the ­patients with UH. The rever­sibil­ity of UH ­becomes more dif­fi­cult if there are com­pli­ca­tions added dur­ing the ­grades of its pro­gres­sion but it may not be nec­es­sar­i­ly fatal and be rever­sible if appro­pri­ate inter­ven­tions are rap­id­ly per­formed.

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