Türk Beyin Damar Hast Derg. 2021; 27(2): 153-159 | DOI: 10.5505/tbdhd.2021.74507

Beyin ölümü ve bilgisayarlý tomografi anjiografi: Kafatasý defektinin etkisi

Tuðçe Mengi¹, Hüseyin Alper Kýzýloðlu², Hadiye Þirin^3
1Niðde Eðitim ve Araþtýrma Hastanesi, Nöroloji Kliniði, Niðde
²Niðde Eðitim ve Araþtýrma Hastanesi, Radyoloji Kliniði, Niðde
³Ege Üniversitesi Týp Fakültesi, Nöroloji Anabilim Dalý, Ýzmir

GÝRÝÞ ve AMAÇ: Beyin ölümü þüphesi olan hastalarda kýrýk ve operasyonlar (kraniyektomi veya kraniyotomi) gibi kafatasý defektileri kafa içi basýncýný düþürebilir ve bilgisayarlý tomografi anjiografi (BTA) gibi destekleyici testler ile taný konmada hatalý sonuçlara yol açabilir. Bu çalýþmada, amacýmýz klinik olarak beyin ölümü teþhisi konulmuþ kafatasý defekti olan ve olmayan hastalarda BTA sonuçlarýný analiz etmektir.
YÖNTEM ve GEREÇLER: Beyin ölümü klinik bulgularýna sahip ve destekleyici test olarak BTA uygulanan hastalar retrospektif olarak deðerlendirildi. Hastalar iki gruba ayrýldý: kafatasý defekti olan grup (kafatasý defekti +) ve kafatasý defekti olmayan grup (kafatasý defekti -).
BULGULAR: Klinik olarak beyin ölümü tanýsý olan ve BTA uygulanan 16 hasta deðerlendirildi. Hastalarýn % 75’inde (12/16) kafatasý defekti olduðu tespit edildi. Kafatasý defekti olan 12 hastanýn 4’ünde kýrýk mevcuttu. Diðer kafatasý defekti olan hastalarýn 6’sýnda kraniyektomi, 2’sinde kraniyotomi mevcuttu. Frampas kriterlerine göre ilk BTA’da 6 hastada (% 37,5) kontrast dolumu saptandý. Ýlk BTA’da kontrast dolumu saptanan hastalarýn tamamýnda kafatasý defekti mevcuttu. Klinik beyin ölümü bulgularý sonrasý kafatasý defekti olan grupta [medyan süre 2 (0,5-7) gün], kafatasý defekti olmayan gruba [medyan süre 0,5 (0,5-0,5) gün] göre radyolojik beyin ölümü tanýsý anlamlý olarak daha geç konuldu (p=0,013).
TARTIÞMA ve SONUÇ: Hasta sayýsý kýsýtlý olsa da çalýþmamýz kafatasý defekti olan hastalarda BTA uygulamasý hakkýndaki zorluklarý göstermiþtir. Bulgularýmýza göre kafatasý defekti olan hastalarda BTA’nýn beyin ölümü tanýsý koymada yanlýþ negatiflik oraný artmaktadýr. Kafatasý defekti olan hastalara beyin ölümü tanýsý daha geç konmaktadýr. Bu bulgular, kafatasý defekti olan hastalarda BTA için farklý deðerlendirme kriterlerinin kullanýlmasý veya BTA dýþýndaki diðer destekleyici testlerin kullanýlmasý konusundaki tartýþmalarý gündeme getirmektedir.

Anahtar Kelimeler: Beyin ölümü, bilgisayarlý tomografi anjiografi, kraniyektomi, kafatasý defekti.

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Brain death and computed tomography angiography: Effect of skull defect

Tuðçe Mengi¹, Hüseyin Alper Kýzýloðlu², Hadiye Þirin^3
1Niðde Training and Research Hospital, Clinic of Neurology, Niðde, Turkey
²Niðde Training and Research Hospital, Clinic of Radiology, Niðde, Turkey
³Ege University Faculty of Medicine, Department of Neurology, Izmir, Turkey

INTRODUCTION: The skull defects such as fractures and operations (craniectomy or craniotomy) in patients with suspected brain death may decrease intracranial pressure and lead to erroneous results in diagnosis with ancillary tests such as computed tomography angiography (CTA). In this study, our aim is to analyze the results of CTA in patients with and without skull defects diagnosed clinically with brain death.
METHODS: Patients with clinical signs of brain death who underwent CTA as a ancillary test were evaluated retrospectively. The patients were categorized into two groups: the group with skull defects (skull defect +) and the group without skull defects (skull defect -).
RESULTS: Sixteen patients with a clinical diagnosis of brain death who underwent CTA were evaluated. It was found that 75% (12/16) of the patients had skull defects. Four of the 12 patients with skull defects had fractures. Six of the patients with skull defects had craniectomy and 2 had craniotomy. Contrast filling was detected in 6 patients (37.5%) at the first CTA according to Frampas criteria. All patients with contrast filling in the first CTA had skull defects. After clinical signs of brain death, radiological brain death was diagnosed significantly later in the group with skull defects [median time 2 (0.5-7) days] than in the group without skull defects [median time 0.5 (0.5-0.5) days], (p = 0.013).
DISCUSSION AND CONCLUSION: Although the number of patients is limited, our study has shown the difficulties in CTA in patients with skull defects. According to our findings, the false negative rate of CTA in brain death diagnosis has increased in patients with skull defects. Brain death has been diagnosed later in patients with skull defects. These findings bring up the controversies about the use of different evaluation criteria for CTA or the use of ancillary tests other than CTA in patients with skull defects.

Keywords: Brain death, computed tomography angiography, craniectomy, skull defect.

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