Author/Editor		Ocepek, Ivan
Title		Urgentna kraniotomija: ali jo lahko in ali jo moramo izvesti v regionalni bolnišnici?
Translated title		Emergency craniotomy: should it be or must be performed in a regional hospital?
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 75, št. 12
Publication year		2006
Volume		str. 805-11
Language		slo
Abstract		Background Most patients with severe head injuries are transported to and operated on in the neurosurgical unit. Some patients are still occasionally operated on in regional hospitals by general surgeons to avert progressive neurological injuries and death. The aim of this paper is to analyze this type of surgical activity in our general hospital. Methods Between 1995 and 2005, 7patients underwent decompressive surgery performed by general surgeons. All were confirmed by the computerized tomography (CT) scan with minimum 5 mm midline shift, severe ventricular compression, or both. We have analyzed the reason why all patients were deemed to be too unstable for transport to the nearest neurosurgical unit which is situated 75 km from our hospital. Results The group of patients consisted of 2 females aged 21-50 years and 5 males aged 32-46 years. All 4 patients with epidural hematoma (EDH) had a good recovering with Glasgow Outcome Scale (GOS) 5 (good recovery with minimal or no disability). With 3 patients with subdural hematoma (SDH), the outcome was not that good and the mean GOS was 2,6, ranging from 4 to 1. The overall mortality was 14.28%. The time from recognition of the nature of the injury by the CT scan to the start of anesthetization ranged from 70 to 20 minutes (with the average of 47 minutes). In EDH, the average time was 37 minutes. Conclusions In a modern society with fast communications, there is enough time to transfer patients with EDH or SDH to a neurosurgical unit before the onset of uncal herniation. The aim is to improve the competence and speed of general hospitals in detection of candidates for surgical decompression, and stress the importance of these patients to be transferred to a neurosurgical unit without any unnecessary delay. The dilemma arises because the condition of patients with expanding mass lesions can deteriorate extremely rapidly, with catastrophic consequences. (Abstract truncated at 2000 characters)
Summary		Izhodišča Večino bolnikov s poškodbo glave in možganov prepeljejo in operirajo na nevrokirurških oddelkih. Občasno pa posamezne bolnike še vedno operirajo splošni kirurgi, da bi s tem preprečili progresivne nevrološke okvare ali smrt. Namen prispevka je analizirati nevrokirurške operacije v naši splošni bolnišnici. Metode V obdobju med letoma 1995 in 2005 je bila pri 7 bolnikih narejena dekompresivna kraniotomija, operacije pa so izvedli splošni kirurgi. Pri vseh je bila diagnoza potrjena z računalniško tomografijo (CT), medialni pomik centralnih struktur možganov je bil preko 5 mm, prisotna je bila kompresija ventriklov ali pa pomik in kompresija. Analizirali smo vzroke, zakaj so kirurgi smatrali, da so bolniki tako nestabilni, da so bili nesposobni za prevoz do najbližjega nevrokirurškega oddelka, ki je od naše bolnišnice oddaljen 75 km. Rezultati Med bolniki sta bili dve ženski, stari 21 in 50 let, in 5 moških, starih od 32 do 46 let. Vsi bolniki z epiduralnim hematomom (EDH) so dobro okrevali in so imeli po glasgowski lestvici okrevanja (GOS) oceno 5 (dober izid z minimalnimi posledicami ali brez). Pri treh bolnikih s subduralnim hematomom (SDH) izid ni bil tako dober in je bil povprečni GOS 2,6 (razpon od 1 do 4). Povprečna smrtnost je bila 14,28%. Med ugotovljeno naravo poškodbe s CT preiskavo glave in začetkom anestezije za operacijo je minilo od 20 do 70 minut (povprečno 47 minut). Pri EDH je bil to povprečni čas 37 minut. Zaključki Bolnike z EDH in SDH je v sodobnih razmerah prevoza možno varno premestiti na nevrokirurške oddelke, preden se razvije slika unkalne herniacije. Zato je treba v splošnih bolnišnicah izboljšati kakovost in hitrost odkrivanja kandidatov za kirurško dekompresijo in te bolnike brez nepotrebnega zamujanja prepeljati na nevrokirurški oddelek. Problem je v tem, da lahko pri bolniku z ekspanzijsko maso pride do skrajno hitrega poslabšanja s katastrofalnimi posledicami. (Izvleček skrajšan pri 2000 znakih)
Descriptors		HEMATOMA, SUBDURAL BRAIN INJURIES CRANIOTOMY HEMATOMA, EPIDURAL HOSPITALS, GENERAL