İdiyopatik intrakraniyal hipertansiyonlu hastalarda tıbbi ve cerrahi tedavi sonuçlarının retrospektif olarak incelenmesi
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Tarih
2022
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Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
İdiyopatik intrakraniyal hipertansiyon (İİH), intrakraniyal yer kaplayıcı lezyon olmaksızın normal serebrospinal sıvı içeriği ve artmış kafa içi basıncı ile karakterize bir klinik tablodur. Bu çalışmada oral karbonik anhidraz inhibitörü tedavisi ve/veya optik sinir kılıf fenestrasyon (OSKF) işlemi uygulanmış İİH tanılı hastaların izlem süreçlerini retrospektif olarak değerlendirmeyi amaçladık. Tekirdağ Namık Kemal Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalında Ocak 2010-Ekim 2021 tarihleri arasında İİH tanısı konulan tanı ve takip sürecinde medikal tedavi verilen 20 olgu Grup 1, cerrahi tedavi uygulanan 14 olgu Grup 2 olarak incelendi. Geriye dönük çalışmada hastaların demografik özellikleri, klinik muayene bulgu ve semptomları, tedavileri, MR görüntülemeleri değerlendirildi. Grup 1 ve Grup 2 hastalarda en sık görülen semptom baş ağrısı idi. Grup 1 hastaların tamamına asetazolamid tedavisi başlandı. Grup 2 hastalara OSKF cerrahisi yapıldı. OSKF uygulanan olgularda en sık endikasyon görme alanı daralması (%92,9) iken cerrahi sonrası en sık komplikasyon diplopi (%21,4) idi. Grup 2 olguların takipler sürecinde hem sağ hem sol göz ortalama en iyi düzeltilmiş görme keskinliklerinde artış gözlendi. Grup 1 hastalarda tanı anında en sık görülen görme kayıp paterni kör nokta genişlemesi iken Grup 2'de ise ciddi daralma idi. Grup 1 ve Grup 2 hastaların ilk ve son muayene ortalama sapma (MD) sonuçları istatistiksel anlamlı idi (p=0,0001). Standart sapma (PSD) ilk muayene ortalamaları karşılaştırıldığında istatistiksel anlamlı fark saptanmazken son muayene ortalamaları istatistiksel anlamlı idi (p<0,05). Grup 1 ve Grup 2 olguların sağ ve sol göz ortalama retina sinir lifi tabakası kalınlık değerleri ilk muayeneye göre azaldı. MR görüntülemede en sık görülen bulgu empty sella idi. Sonuç olarak İİH hastalarında doğru hasta yönetimi ile görsel işlevlerde önemli kayıplar önlenebilir. Cerrahi tedavide OSKF, medikal tedavide asetazolamid güvenilir seçeneklerdir.
Idiopathic intracranial hypertension (IIH) is a clinical picture characterized by normal cerebrospinal fluid content and increased intracranial pressure without intracranial space-occupying lesions. In this study, we aimed to retrospectively evaluate the follow-up processes of patients with IIH who underwent oral carbonic anhydrase inhibitor therapy and/or optic nerve sheath fenestration (ONSF). In Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Ophthalmology, 20 patients diagnosed with IIH between January 2010 and October 2021, who were given medical treatment during the diagnosis and follow-up, were analyzed as Group 1, and 14 patients who underwent surgical treatment as Group 2. In the retrospective study, demographic characteristics of the patients, clinical examination signs and symptoms, treatments and MR scans were evaluated. Headache was the most common symptom in Group 1 and Group 2 patients. All patients in Group 1 were started on acetazolamide treatment. ONSF surgery was performed on Group 2 patients. While the most common indication was narrowing of the visual field (92,9%) in patients who underwent ONSF, the most common complication after surgery was diplopia (21,4%). In the follow-up of Group 2 cases, an increase in mean best corrected visual acuity was observed in both the right and left eyes. Blind spot enlargement was the most common vision loss pattern at the time of diagnosis in patients in Group 1, while severe narrowing was observed in Group 2. The mean deviation (MD) results of the first and last examinations of the patients in Group 1 and Group 2 were statistically significant (p=0,001). When the standard deviation (PSD) first examination averages were compared, no statistically significant difference was found, while the last examination averages were statistically significant (p<0,05). The mean retinal nerve fiber layer thickness values of the right and left eyes of Group 1 and Group 2 cases decreased compared to the first examination. The most common finding on MR was empty sella. In conclusion, significant losses in visual functions can be prevented with correct patient management in IIH patients. ONSF in surgical treatment and acetazolamide in medical treatment are reliable options.
Idiopathic intracranial hypertension (IIH) is a clinical picture characterized by normal cerebrospinal fluid content and increased intracranial pressure without intracranial space-occupying lesions. In this study, we aimed to retrospectively evaluate the follow-up processes of patients with IIH who underwent oral carbonic anhydrase inhibitor therapy and/or optic nerve sheath fenestration (ONSF). In Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Ophthalmology, 20 patients diagnosed with IIH between January 2010 and October 2021, who were given medical treatment during the diagnosis and follow-up, were analyzed as Group 1, and 14 patients who underwent surgical treatment as Group 2. In the retrospective study, demographic characteristics of the patients, clinical examination signs and symptoms, treatments and MR scans were evaluated. Headache was the most common symptom in Group 1 and Group 2 patients. All patients in Group 1 were started on acetazolamide treatment. ONSF surgery was performed on Group 2 patients. While the most common indication was narrowing of the visual field (92,9%) in patients who underwent ONSF, the most common complication after surgery was diplopia (21,4%). In the follow-up of Group 2 cases, an increase in mean best corrected visual acuity was observed in both the right and left eyes. Blind spot enlargement was the most common vision loss pattern at the time of diagnosis in patients in Group 1, while severe narrowing was observed in Group 2. The mean deviation (MD) results of the first and last examinations of the patients in Group 1 and Group 2 were statistically significant (p=0,001). When the standard deviation (PSD) first examination averages were compared, no statistically significant difference was found, while the last examination averages were statistically significant (p<0,05). The mean retinal nerve fiber layer thickness values of the right and left eyes of Group 1 and Group 2 cases decreased compared to the first examination. The most common finding on MR was empty sella. In conclusion, significant losses in visual functions can be prevented with correct patient management in IIH patients. ONSF in surgical treatment and acetazolamide in medical treatment are reliable options.
Açıklama
Anahtar Kelimeler
İdiyopatik intrakraniyal hipertansiyon, papilödem, optik sinir kılıf fenestrasyonu., Idiopathic intracranial hypertension, papilledema, optic nerve sheath fenestration., Göz Hastalıkları, Eye Diseases
