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

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


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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