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  • Küçük Resim
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    Angiographic embolization in epistaxis: Our clinical experience and results
    (2021) Cicek, Mehmet Turan; Yildirim, İsmail Okan; Bayindir, Tuba; Sarac, Kaya; Tan, Mehmet; Aslan, Mehmet; Ozer Ozturk, Ebru
    Aim: Nosebleed, more commonly called epistaxis is a general clinical problem, and the most of bleedings can be treated non-invasive approach. However, because of persistent and sometimes life-threatening bleeding, additional treatment such as super-selective embolization may be required. In this study, we report our data on the endovascular treatment of persistent epistaxis. Materials and Methods: Between January 2010 and December 2019, all patients who were followed up at Inonu University Turgut Ozal Medical Center Otorhinolaryngology Clinic due to recurrent persistent nosebleed and required endovascular treatment were retrospectively screened. Demographic data, cause of epistaxis, localization of the bleeding, the clinical significance of the bleeding, interventional approach, complications related to treatment, and results were evaluated. Results: All of 18 patients with intractable epistaxis were included in the study. Depending on the etiology of epistaxis, patients were determined into three groups: idiopathic epistaxis (10/18), iatrogenic or traumatic epistaxis (7/18), and nasopharyngeal cancer (1/18). Nine of 18 patients required blood transfusions. The internal maxillary artery was embolized unilaterally in 12 of 18 (66%) and bilaterally in 2 of 18 (11%) procedures. Four patients were not embolized because of bleeding originated from ethmoidal branches of the ophthalmic artery. These four patients were operated on (endoscopic ethmoidectomy and bleeding control). Long-term success rates of embolization were 14 of 14. Major complications (transient hemiparesis) occurred in one patient after embolization. Conclusion: Endovascular approach proves to be effective for intractable and fatal epistaxis. Embolization has a good risk-benefit ratio in persistent bleeding. However, if bleeding is originated by the ethmoidal branches of the ophthalmic artery, embolization may not be performed to avoid visual complications.
  • Küçük Resim
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    Non-traumatic non-aneurysmal subarachnoid haemorrhage: Single institutional experience
    (202) Pasahan, Ramazan; Tetik, Bora; Guldogan, Emek; Durak, M. Akif; Yildirim, İsmail Okan
    Aim: Despite the advanced diagnostic methods we use today, the rate of negative digital subtraction angiography (DSA) is 15% in patients diagnosed with subarachnoidal hemorrhage (SAH), and these types of hemorrhages are named as non-aneurysmal (NASAH). Various factors such as inadequate interpretation of the beginning angiography, vasospasm, thrombosis, intra-cerebral hematoma pressure may cause DSA to be negative. This study aims to determine the causes of bleeding in patients who were suffered from NASAH. Materials and Methods: The study evaluated 664 patients with SAH from 2010 to 2016. DSA was performed on these patients within the first 3 or 6 hours. Sixty-seven patients with DSA negative were included in the study group. The patients were divided into three groups as perimesencephalic subarachnoidal hemorrhage (PMSAH), non-perimesencephalic subarachnoidal hemorrhage (nPMSAH), CT negative subarachnoidal hemorrhage (CT negative SAH). These three groups were evaluated based on age, gender, Glascow coma scale (GCS), World Federation of Neurosurgical Societies (WFNS) grade, Hunt and Hess Classification and Fisher’s scale, hospitalization time duration, complications and computerized tomography (CT), and cervical and cranial MRI was performed on patients without correlation between DSA results if needed. Results: Of the 664 patients diagnosed with SAH, 67 (10.09%) had NASAH. Statistically significant differences were found between CT Negative SAH and PMSAH and CT Negative SAH and nPMSAH in terms of the variables of GCS during hospital admission and total duration of hospitalization. Statistically significant differences were found between CT Negative SAH and PMSAH and nPMSAH in terms of the variables of GCS during hospital discharge. There were statistically significant differences between the types in terms of WFNS Classification, Hunt and Hess Classification and Fisher’s Scala. Conclusion: We believe that this study will contribute to the literature about the necessity of performing additional radiologic imaging during clinical follow-up since belated diagnosis in patients with NASAH may increase mortality.