Beyin t\u00fcm\u00f6rlerinin g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 100 bin ki\u015fide 3,8 ile 5,1 aras\u0131nda de\u011fi\u015fir. Kansere ba\u011fl\u0131 \u00f6l\u00fcmlerin y\u00fczde 2,7’si beyin t\u00fcm\u00f6rlerinin sonucudur; \u00f6l\u00fcm endeksi her 100 bin ki\u015fide, erkeklerde 3,3, kad\u0131nlarda ise 2,3\u2032t\u00fcr. Beyin t\u00fc\u00adm\u00f6rleri \u00e7ocukluk \u00e7a\u011f\u0131nda kan kanser\u00adleri ve k\u00f6t\u00fc huylu lenfomlardan sonra en s\u0131k g\u00f6r\u00fclen t\u00fcm\u00f6r grubunu olu\u015ftu\u00adrur; bu ya\u015flarda rastlanan k\u00f6t\u00fc huylu t\u00fcm\u00f6rlerin y\u00fczde 20-25\u2032i beyin t\u00fcm\u00f6r\u00adleridir.<\/p>\n
Travma, vir\u00fcs, ailevi yatk\u0131nl\u0131k gibi et\u00admenleri ortaya \u00e7\u0131karmaya y\u00f6nelik \u00e7al\u0131\u015f\u00admalar varsa da, bu t\u00fcm\u00f6rlerin k\u00f6keni halen bilinmemektedir. Baz\u0131 t\u00fcm\u00f6rler belirgin bir bi\u00e7imde \u201cembriyonal\u201d ve do\u011fumsal\u201dd\u0131r; baz\u0131lar\u0131 ise ya\u015fam\u0131n ile\u00adri evrelerinde ortaya \u00e7\u0131kar.<\/p>\n
BEL\u0130RT\u0130LER\u0130<\/p>\n
Beyin t\u00fcm\u00f6rleri g\u00f6r\u00fclme s\u0131kl\u0131kla olarak \u015fu belirtiler verirler: \u0130lerleyici n\u00f6rolojik kusur(%68) genellikle burada bahsedilen kuvvet zay\u0131fl\u0131\u011f\u0131d\u0131r.(%45). Ba\u015f a\u011fr\u0131s\u0131 %54, n\u00f6bet g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 ise %20-40` d\u0131r. \u00d6zellikle 20 ya\u015f\u0131n \u00fczerinde;\u00a0 n\u00f6betle gelen hastalarda, t\u00fcm\u00f6r yo\u011fun olarak ara\u015ft\u0131r\u0131lmal\u0131d\u0131r. Kafai\u00e7i t\u00fcm\u00f6rleri yukar\u0131daki ana belirtileri vermekle beraber, belirtiler iki ana grupta incelenmelidir. Birinci gruptakiler genel belirtiler olarak adland\u0131r\u0131l\u0131r. Bunlar, yerle\u015fimleri neresi olursa olsun b\u00fct\u00fcn kafai\u00e7i t\u00fc\u00adm\u00f6rleri a\u00e7\u0131s\u0131ndan ortak belirtilerdir. \u0130kinci grup belirtiler ise t\u00fcm\u00f6r\u00fcn yerle\u00ad\u015fimine ba\u011fl\u0131d\u0131r. Genel belirtiler – Bu belirtiler kafai\u00e7i Bas\u0131n\u00e7 artmas\u0131na ba\u011fl\u0131d\u0131r; gerek t\u00fcm\u00f6r k\u00fctlesinden, gerek beyin-omurilik s\u0131v\u0131s\u0131 dola\u015f\u0131m\u0131ndaki bozukluklardan kaynak\u00adlan\u0131rlar. Ayn\u0131 belirtiler, beyin-omurilik s\u0131v\u0131s\u0131n\u0131n a\u015f\u0131n \u00fcretimine ve S\u0131v\u0131 ak\u0131m\u0131\u00adn\u0131n engellenmesine (t\u0131kay\u0131c\u0131 hidrosefali [beyin kar\u0131nc\u0131klar\u0131nda a\u015f\u0131n beyin-omurilik s\u0131v\u0131s\u0131 birikmesi]) ba\u011fl\u0131 olarak kafai\u00e7i bas\u0131n\u00e7 artmas\u0131n\u0131n s\u00f6z konusu oldu\u011fu hastal\u0131klarda da g\u00f6r\u00fcl\u00fcr. Bu be\u00adlirtilerin hepsine birden kafai\u00e7i bas\u0131n\u00e7 art\u0131\u015f\u0131 sendromu (K\u0130BAS) ad\u0131 verilir. Genel belirtilerin en \u00f6nemlileri ba\u015f a\u011fr\u0131s\u0131, kusma ve papilla (k\u00f6r nokta) staz\u0131d\u0131r. \u0130lave olarak daha seyrek g\u00f6r\u00fclen ama olduk\u00e7a anlaml\u0131 olan zihinsel uyu\u015fuk\u00adluk, uykuya e\u011filim ve nab\u0131z azalmas\u0131n\u0131 da eklemek gerekir.<\/p>\n
Ba\u015f a\u011fr\u0131s\u0131: En s\u0131k ve en erken g\u00f6r\u00fc\u00adlen belirtidir, genellikle \u015fiddetlidir. S\u00fc\u00adrekli olabilir, seyrek olarak da ba\u015flan\u00adg\u0131\u00e7 evresinde n\u00f6betler halinde gelir. Baz\u0131 olgularda yo\u011fun ve y\u0131rt\u0131c\u0131d\u0131r. \u00d6zellik\u00adte, baz\u0131lar\u0131nda ise daha hafif n\u00f6betler bi\u00e7imde gittik\u00e7e \u015fiddetlenerek seyreder. Genellikle arka kafa \u00e7ukuru t\u00fcm\u00f6rlerinde, \u00f6teki b\u00f6lgelerdekine oranla daha erken ve \u015fiddetlidir. Bu t\u00fcm\u00f6rlerde belirtiler genellikle ani ve \u00e7ok \u015fiddetli ba\u015f a\u011fr\u0131s\u0131 ile ba\u015flar. T\u00fcm\u00f6r k\u00fctlesinin d\u00f6rd\u00fcnc\u00fc kar\u0131nc\u0131\u011fa yapt\u0131\u011f\u0131 bask\u0131 sonucu beyin-omurilik s\u0131v\u0131s\u0131 dola\u015f\u0131m\u0131n\u0131n engellenme\u00adsi (hidrosefali) K\u0130BAS yaparak kusma\u00adya da neden olur. Ba\u015f a\u011fr\u0131s\u0131 yayg\u0131n, ya da yerel \u00f6zel\u00adlikte olabilir. Ba\u015f a\u011fr\u0131s\u0131n\u0131n \u015fiddeti v\u00fccudun konu\u00admuna g\u00f6re de\u011fi\u015febilir; genellikle dik duruldu\u011funda \u015fiddetlenir, yat\u0131ld\u0131\u011f\u0131nda azal\u0131r.<\/p>\n
Kusma: Kafai\u00e7i bas\u0131n\u00e7 artmas\u0131na ba\u011f\u00adl\u0131 kusma yemeklerle ilgili de\u011fildir; bu\u00adlant\u0131 g\u00f6r\u00fclmez, f\u0131\u015fk\u0131rma bi\u00e7imindedir. Bu \u00f6zellikleri nedeniyle beyin k\u00f6kenli kusmaya kolay kusma (bulant\u0131s\u0131z kus\u00adma) da denir; ama bu \u00f6zelliklerin de\u011fi\u00ad\u015fiklik g\u00f6sterdi\u011fi de olur. Kusma daha \u00e7ok sabahlan a\u00e7 karn\u0131na g\u00f6r\u00fcl\u00fcr. Baz\u0131 olgularda yemeklerden ya da biraz Su i\u00e7tikten sonra bulant\u0131yla da ortaya \u00e7\u0131kabilir ve halsizlik yaratabilir.\u00a0 Beyin k\u00f6kenli kusma, arka kafa \u00e7uku\u00adru t\u00fcm\u00f6rlerinde \u00f6teki b\u00f6lgelerin t\u00fcm\u00f6r\u00adlerine oranla daha s\u0131k g\u00f6r\u00fcl\u00fcr.<\/p>\n
Epilepsi(Sara): Beyin yar\u0131mk\u00fcrelerinin \u00f6zellikle \u015fakak lobu(temporal lob) t\u00fcm\u00f6rlerin\u00adde ortaya \u00e7\u0131kar. Beyin t\u00fcm\u00f6r\u00fc olgula\u00adr\u0131nda ortaya \u00e7\u0131kan yayg\u0131n \u00e7\u0131rp\u0131nma n\u00f6\u00adbetleri t\u00fcm\u00f6r\u00fcn yerel bir belirtisi ola\u00adrak kabul edilmelidir. Kafai\u00e7i bas\u0131n\u00e7 artmas\u0131n\u0131n erken ve a\u011f\u0131r oldu\u011fu arka kafa bo\u015flu\u011fu t\u00fcm\u00f6rlerinde \u00e7\u0131rp\u0131nma n\u00f6beti \u00e7ok seyrek g\u00f6r\u00fcl\u00fcr. Oysa \u015fakak lobu(temporal lob) t\u00fcm\u00f6rlerinde, \u00e7\u0131rp\u0131nma n\u00f6betleri kafai\u00ad\u00e7i bas\u0131n\u00e7 artmas\u0131 belirtilerinden \u00e7ok \u00f6nce (bazen y\u0131llarca \u00f6nce) ortaya \u00e7\u0131ka\u00adbilir.<\/p>\n
Zihinsel uyu\u015fukluk: Zihinsel uyu\u015fuk\u00adluk duygularda kabala\u015fma, alg\u0131lamada gecikme ve d\u00fc\u015f\u00fcnsel i\u015flevlerde yava\u015f\u00adlama bi\u00e7iminde ortaya \u00e7\u0131kar. Hasta ka\u00ady\u0131ts\u0131z, apatik (duyumsamaz) ve dikkat\u00adsiz g\u00f6r\u00fcn\u00fcr; kavrama yetene\u011fi azalm\u0131\u015f\u00adt\u0131r ve sorular\u0131 ge\u00e7 yan\u0131tlar. Zihinsel uyu\u015fukluk beyincik t\u00fcm\u00f6rlerinde az g\u00f6r\u00fcl\u00fcr, Al\u0131n lobu ba\u015fta olmak \u00fczere beyin yar\u0131mk\u00fcrelerinin t\u00fcm\u00f6rlerinde de\u00ad\u011fi\u015fmez bir belirtidir. Ama al\u0131n lobu t\u00fc\u00adm\u00f6rlerinde zihinsel uyu\u015fukluktan \u00e7ok daha fazla olmak \u00fczere \u015fiddetli ruhsal bozukluklar g\u00f6zle\u00adnir. Daha \u00e7ok zihinsel uyu\u015fukluk g\u00f6r\u00fc\u00adlen olgularda ise esneme s\u0131k rastlanan bir belirtidir.<\/p>\n
Endokrin bozukluk: Baz\u0131 sella tursica(T\u00fcrk e\u011feri) b\u00f6lgesi t\u00fcm\u00f6rleri ise endokrin bozukluklar, g\u00f6rme bozukluklar\u0131 ve baz\u0131 kraniyal sinir tutulmalar\u0131 yapabilir. Bunlar\u0131n olu\u015fumundan sonra hastay\u0131 h\u0131zl\u0131 Ameliyata almak i\u015flev kurtulumu veya hayat kurtulumuna sebep olur.\u00a0\u00a0<\/p>\n
\u00d6zet olarak, kafai\u00e7i t\u00fcm\u00f6rleri; ba\u015f a\u011fr\u0131s\u0131, kusma, papilla staz\u0131, nabz\u0131n seyrekle\u015fmesi ve zihinsel uyu\u00ad\u015fukluklarla belirti verirler. \u0130lk \u00fc\u00e7\u00fc \u00f6zellikle arka kafa bo\u015f\u00adlu\u011fu t\u00fcm\u00f6rlerinde s\u0131k rastlan\u0131r, erken ortaya \u00e7\u0131kar ve a\u011f\u0131r bir tablo olu\u015fturur; zihinsel uyu\u015fukluk ise beyin yar\u0131mk\u00fcrele\u00adrinin t\u00fcm\u00f6rlerinde yayg\u0131nd\u0131r.<\/p>\n
Odaksal ve yerel belirtiler. T\u00fcm\u00f6r k\u00fctlesi, genel belirtilerin yan\u0131 s\u0131ra yer\u00adle\u015fime ba\u011fl\u0131 \u00f6zg\u00fcl bozukluklara da ne\u00adden olur.<\/p>\n
Beyin kabu\u011fundan kaynaklanan bozukluklar; En s\u0131k g\u00f6r\u00fclen sendromlar \u015funlard\u0131r:<\/p>\n
Rolando sendromu. Beynin Rolando yar\u0131\u011f\u0131 olarak da bilinen orta olu\u011fu, ha\u00adreket ve duyu merkezlerini birbirinden ay\u0131r\u0131r. Rolando sendromu t\u00fcm\u00f6r\u00fcn kar\u00ad\u015f\u0131s\u0131ndaki beyin yar\u0131mk\u00fcresinde g\u00f6r\u00fclen kas\u0131lma ile birlikte ortaya \u00e7\u0131kan g\u00fc\u00e7 azalmas\u0131 (spastik hemiparezi) bi\u00e7imin\u00addeki hareket bozukluklar\u0131d\u0131r. Bazen g\u00f6\u00adr\u00fclen basit yerel fel\u00e7lere, bacaklarda kollara oranla daha \u00e7ok rastlan\u0131r. \u00d6z\u00adg\u00fcn bir belirti de k\u0131smi \u00e7\u0131rp\u0131nma n\u00f6bet\u00adleridir. Duyu bozukluklar\u0131 ise daha az g\u00f6r\u00fcl\u00fcr ve daha ge\u00e7 ortaya \u00e7\u0131kar. <\/p>\n
Al\u0131n lobu sendromu. Bu sendromu olu\u015fturan belirtiler, kas gerginli\u011fi de\u011fi\u00ad\u015fiklikleri; ekstrapiramidal sistem belir\u00adtileri; genellikle bir \u00e7\u0131rp\u0131nma n\u00f6betinin ba\u015f\u0131nda g\u00f6r\u00fclen, g\u00f6z ve ba\u015f\u0131n birlikte bir yana kaymas\u0131; denge ve hareketler\u00adde e\u015fg\u00fcd\u00fcm bozukluklar\u0131 (frontal ataksi); idrar ve d\u0131\u015fk\u0131 bozukluklar\u0131 ile bir\u00adlikte otonom sinir sistemi d\u00fczensizlik\u00adleri; konu\u015fma g\u00fc\u00e7l\u00fc\u011f\u00fc (afazi) ve ruhsal de\u011fi\u015fikliklerdir. Ruhsal de\u011fi\u015fiklikler( bellek bozuklu\u011fu), mutizm (dilsizlik) , hareket insiyatif bozukluklar\u0131, a\u015f\u0131r\u0131 ne\u015felenme y\u00f6n\u00fcnde ki\u015filik bozukluklar\u0131d\u0131r.<\/p>\n
Yan kafa lobu sendromu. \u00d6znel ve nesnel duyu bo\u00adzukluklar\u0131 g\u00f6r\u00fcl\u00fcr. \u00d6znel duyu bozukluklar\u0131 kar\u0131ncalanma ve uyu\u015fmad\u0131r. Nesnel duyu bozukluklar\u0131 ise, duru\u015f alg\u0131lamas\u0131nda ki; ac\u0131, \u0131s\u0131, dokunma uyaranlar\u0131n\u0131 ay\u0131rt etme yetene\u011findeki; cisimlerin bi\u00ad\u00e7im, a\u011f\u0131rl\u0131k, Hacim ve i\u00e7eri\u00ad\u011fini tan\u0131madaki de\u011fi\u015fiklik\u00adlerle ortaya \u00e7\u0131kar. Kas erimesi (atrofi) bi\u00e7imindeki bozukluklar ile g\u00f6rme ve tat bozukluklar\u0131 da g\u00f6r\u00fclebilir. <\/p>\n
\u015eakak lobu sendromu. Beyin yar\u0131mk\u00fcre\u00adlerinin \u015fakak lobu lezyonlar\u0131 bask\u0131n olan beyin yar\u0131mk\u00fcresindeyse konu\u015fma bozukluklar\u0131 \u00f6ne \u00e7\u0131kar. Arka kafa lobunun derinliklerindeki lezyonlar ise g\u00f6rme bozukluklar\u0131na yol a\u00e7ar. Sara n\u00f6betleri s\u0131kt\u0131r. G\u00f6rme, i\u015fitme, tat ve koku varsan\u0131lar\u0131 t\u00fcm\u00f6r\u00fcn yerini belirlemede \u00f6nem ta\u015f\u0131r.Arka kafa lobu sendromu. G\u00f6rme bozuk\u00adluklar\u0131, varsan\u0131lar ya da g\u00f6rsel yan\u0131lsa\u00admalardan olu\u015fur. Arka \u00e7ukur sendromu; t\u00fcm arka \u00e7ukur t\u00fcm\u00f6rlerinde beyin-omurilik s\u0131v\u0131\u00ads\u0131 dola\u015f\u0131m\u0131n\u0131n bir engelle kar\u015f\u0131la\u015fmas\u0131, erken ve giderek a\u011f\u0131rla\u015fan bir kafai\u00e7i bas\u0131n\u00e7 artmas\u0131 sendromuna neden olur. \u0130ki bi\u00e7imi vard\u0131r:<\/p>\n
Beyincik loblar\u0131n\u0131n sendromu. Dismetri (kas hareketlerinde uzakl\u0131\u011f\u0131 sa\u011flayamama), asinerji (kaslarda e\u015fg\u00fcd\u00fcm kusuru), kas gerginli\u011finde azalma, edil\u00adgenlik artmas\u0131 gibi hareketlerle ilgili be\u00adyinci\u011fe ba\u011fl\u0131 bozukluklar tabloya ege\u00admendir. Bunlara nistagmus (g\u00f6z titre\u00admesi), ba\u015f d\u00f6nmesi ve y\u00fcr\u00fcme bozuk\u00adluklar\u0131 da eklenir.Orta \u00e7izgi (linea mediana) sendromu. Denge yitimi ve geriye do\u011fru y\u00fcr\u00fcme e\u011filimi gibi denge bozukluklar\u0131 her za\u00adman \u00f6n plandad\u0131r. Kusma ve otonom sinir sisteminin \u00f6teki i\u015flevlerin\u00adde bozulma da tabloya eklenir.<\/p>\n
TANI<\/p>\n
Teknolojideki geli\u015fmeler tan\u0131ya varma\u00adda hekimlere b\u00fcy\u00fck kolayl\u0131klar sa\u011fla\u00adm\u0131\u015ft\u0131r. G\u00fcn\u00fcm\u00fczde bilgisayarl\u0131 beyin tomografisi (BBT) ve magnetik rezo\u00adnans (MR) gibi yan\u0131lma pay\u0131n\u0131 \u00e7ok azaltan inceleme y\u00f6ntemlerinin geli\u015fti\u00adrilmesiyle, beyin t\u00fcm\u00f6rleri ve \u00f6teki ka\u00adfai\u00e7i yer kaplayan hastal\u0131klar\u0131n tan\u0131s\u0131 \u00e7ok kolayla\u015fm\u0131\u015ft\u0131r. Anjiyografinin (kontrast Madde verilerek damarlar\u0131n g\u00f6r\u00fcnt\u00fclenmesi) \u00d6zellikle beyin damar\u00adlar\u0131ndaki hastal\u0131klar\u0131n tan\u0131s\u0131nda \u00f6nemli yeri vard\u0131r. Pn\u00f6moensefalografi ve ventrik\u00fclografi eskiden oldu\u011fu kadar s\u0131k kullan\u0131lmamaktad\u0131r. Ekoensefalografi ise yeni do\u011fanlarda, \u00f6zellikle hidro\u00adsefali tan\u0131s\u0131nda \u00e7ok ge\u00e7erli bir y\u00f6ntem\u00addir.<\/p>\n
Kafa filmi – Kafa filmi al\u0131nd\u0131\u011f\u0131nda beyin t\u00fcm\u00f6r\u00fc olgular\u0131n\u0131n yakla\u015f\u0131k y\u00fcz\u00adde 30\u2032unda de\u011fi\u015fiklik g\u00f6r\u00fcl\u00fcr. Kafa fil\u00admi, kafai\u00e7i s\u00fcre\u00e7le ilgili do\u011frudan ya da dolayl\u0131 belirtilerin ortaya konmas\u0131n\u0131 sa\u011flar. Do\u011frudan belirtilerin ba\u015fl\u0131calar\u0131; y\u00fczde 6\u20138 oran\u0131nda g\u00f6r\u00fclen kalsiyum \u00e7\u00f6keltileri, t\u00fcm\u00f6r\u00fcn do\u011frudan etkisiyle kemiklerde ger\u00e7ekle\u015fen doku y\u0131k\u0131mlar\u0131 ve dokular\u0131n yer de\u011fi\u015ftirmeleridir. Do\u00adlayl\u0131 belirtiler ise kafai\u00e7i bas\u0131n\u00e7 artmas\u0131 sonucu ortaya \u00e7\u0131kar(d\u00f6\u011f\u00fclm\u00fc\u015f Bak\u0131r manzaras\u0131).\u00a0<\/p>\n
Ekoensefalografi – \u00d6teki tan\u0131 y\u00f6n\u00adtemleriyle birlikte uygulanan basit bir incelemedir; tan\u0131ya ula\u015fmak i\u00e7in tek ba\u00ad\u015f\u0131na yeterli de\u011fildir. <\/p>\n
Bilgisayarl\u0131 beyin tomografisi (BBT) ve magnetik rezonans (MR) – Kafai\u00e7i t\u00fcm\u00f6rlerin tan\u0131s\u0131nda en yararl\u0131 tan\u0131 y\u00f6ntemleridir. Bu y\u00f6ntemlerle t\u00fc\u00adm\u00f6r\u00fcn Sa\u011fl\u0131kl\u0131 beyin dokular\u0131ndan ay\u0131rt edilmesi sa\u011flan\u0131r. Uygulanmas\u0131 kolay oldu\u011fundan, damar yoluyla ger\u00ad\u00e7ekle\u015ftirilen y\u00f6ntemlerden \u00f6nce ba\u015fvu\u00adrulur. <\/p>\n
Beyin anjiyografisi – Y\u0131llard\u0131r beyin t\u00fcm\u00f6rlerinin tan\u0131s\u0131nda temel y\u00f6ntemler\u00adden biri olarak yayg\u0131n bir bi\u00e7imde kul\u00adlan\u0131lmaktad\u0131r. Uyluktan ya da \u015fahdamar\u0131ndan soku\u00adlan bir kateter ile yap\u0131l\u0131r. T\u00fcm\u00f6r\u00fcn damarlanmas\u0131 ve b\u00fcy\u00fck damarlar\u0131n yer de\u011fi\u015ftirmesi gibi belirtiler ile t\u00fcm\u00f6r\u00fcn tan\u0131s\u0131na yard\u0131mc\u0131 olur. Beyin cerrahlar\u0131\u00adn\u0131n t\u00fcm\u00f6r i\u00e7i ve \u00e7evresindeki damarlanmay\u0131 kavramalar\u0131na yard\u0131mc\u0131 olur. \u00d6b\u00fcr y\u00f6ntemlere oranla tart\u0131\u015fmas\u0131z \u00fcs\u00adt\u00fcnl\u00fckleri olan anjiyografinin uygulan\u00admas\u0131nda baz\u0131 tehlikeler de s\u00f6z konusu\u00addur. Anjiyografi yap\u0131lan hastalar\u0131n y\u00fcz\u00adde 3-5’inde tek yanl\u0131 fel\u00e7 ya da g\u00fc\u00e7 azalmas\u0131, konu\u015fma g\u00fc\u00e7l\u00fckleri, bilin\u00e7 bozuklu\u011fu, koma, \u00e7\u0131rp\u0131nma n\u00f6betleri gibi komplikasyonlar g\u00f6r\u00fclebilir. Bu is\u00adtenmeyen sonu\u00e7lar\u0131n b\u00fcy\u00fck bir b\u00f6l\u00fcm\u00fc ge\u00e7icidir, bir s\u00fcre sonra iyile\u015fme g\u00f6r\u00fc\u00adl\u00fcr. Kal\u0131c\u0131 bozukluklar\u0131n g\u00f6r\u00fclme oran\u0131 yaln\u0131zca binde 9\u2032dur. Bug\u00fcn i\u00e7in beyin t\u00fcm\u00f6rlerinin tan\u0131s\u0131nda etkinli\u011fi \u00e7ok azalm\u0131\u015ft\u0131r.\u00a0Pn\u00f6moensefalografi ve ventrik\u00fc\u00adlografi – Uygulamalar\u0131 birbirine ben\u00adzedi\u011fi i\u00e7in, beyin kar\u0131nc\u0131klar\u0131(ventrik\u00fclleri) sistemi ve \u00f6r\u00fcmceksi (araknoit) zar alt\u0131 bo\u015f\u00adluklar\u0131n incelenmesinde birlikte kulla\u00adn\u0131l\u0131rlar. Tan\u0131 kar\u0131nc\u0131k ya da sarn\u0131\u00e7 sis\u00adtemindeki(sisternalar) bask\u0131, yer de\u011fi\u015fikli\u011fi ve bi\u00ad\u00e7im bozukluklar\u0131n\u0131n g\u00f6r\u00fclmesi ile ko\u00adnur. Bilgisayarl\u0131 tomografi ve manye\u00adtik rezonans bulunduktan sonra bu y\u00f6ntemlerin kullan\u0131m\u0131 azalm\u0131\u015ft\u0131r. Ama \u00f6zellikle beyin orta hatt\u0131n\u0131n derin lezyonlar\u0131n\u0131n tan\u0131s\u0131nda (II. ve IV. kar\u0131n\u00adc\u0131k, T\u00fcrk eyeri b\u00f6lgesi) eskiden kullan\u0131m\u0131 fazla bir y\u00f6ntemdir. Bug\u00fcn hemen hemen kul\u00adlan\u0131lmamaktad\u0131rlar. Uygulama sonras\u0131nda seyrek olarak bulant\u0131, kusma ve ba\u015f a\u011fr\u0131s\u0131 gibi istenmeyen sonu\u00e7lar geli\u015fe\u00adbilir. \u00d6l\u00fcmle sonlanan olgular binde 2\u2032yi ge\u00e7mez.<\/p>\n
Elektroensefalograf\u0131 (EEG) – Ge\u00e7\u00admi\u015f y\u0131llarda s\u0131k kullan\u0131lan bu y\u00f6ntem, g\u00fcn\u00fcm\u00fczde beyin t\u00fcm\u00f6rlerinin tan\u0131s\u0131nda \u00f6nemini korumamaktad\u0131r. \u00d6zellikle kafai\u00e7i yay\u0131l\u0131m g\u00f6steren bir s\u00fcrecin varl\u0131\u011f\u0131n\u0131 kan\u0131tlamada ve bazen de yerini saptamada yararl\u0131d\u0131r. Ama el\u00adde edilen bilgiler hi\u00e7bir zaman, cerrahi giri\u015fim i\u00e7in yeterli bulgu sa\u011flayamaz. EEG’de hastal\u0131k d\u00fc\u015f\u00fcnd\u00fcren ritimlerin ortaya \u00e7\u0131kmas\u0131yla t\u00fcm\u00f6r\u00fcn varl\u0131\u011f\u0131 ara\u00ads\u0131nda bir ili\u015fki saptanm\u0131\u015fsa da, bu y\u00f6n\u00adtem yaln\u0131zca yol g\u00f6sterici bir tan\u0131 arac\u0131\u00add\u0131r, ard\u0131ndan daha duyarl\u0131 inceleme y\u00f6ntemleri uygulanmal\u0131d\u0131r.\u00a0<\/p>\n
Biyopsi – Beyin t\u00fc\u00adm\u00f6r\u00fc d\u00fc\u015f\u00fcn\u00fclen bir yer kaplay\u0131c\u0131 lezyonun tan\u0131s\u0131 biyopsi ile (doku \u00f6r\u00adne\u011fi al\u0131nmas\u0131) kesinle\u015ftirilebilir. Al\u0131\u00adnan doku \u00f6rne\u011finin yeterli miktarda ve tan\u0131ya varmak i\u00e7in uygun olmas\u0131 temel ko\u015fuldur. Beyin biyopsisinin uygula\u00admas\u0131ndaki ba\u015fl\u0131ca tehlikeler \u015funlard\u0131r: Al\u0131nan \u00f6rne\u011fin azl\u0131\u011f\u0131ndan \u00f6t\u00fcr\u00fc ya da biyopsinin, patolojiyi tam olarak yans\u0131tma\u00adyan bir b\u00f6lgeden yap\u0131lmas\u0131 sonucunda yanl\u0131\u015f tan\u0131ya varmak (olgular\u0131n y\u00fczde 37’si); kanama (y\u00fczde 5); beyin \u015fi\u015fmesi (y\u00fczde 20). Bu tehlikeli durum ko\u00adruyucu olarak y\u00fcksek doz kortikosteroit grubu ila\u00e7 verilerek k\u0131smen \u00f6nlenebilir. Son y\u0131llarda uygulanan stereotaktik cerrahi sayesinde bu tehlikeler \u00f6nemli \u00f6l\u00e7\u00fcde azalm\u0131\u015ft\u0131r. Beyin t\u00fcm\u00f6rleri; be\u00adyin apseleri, kistler, t\u00fcberk\u00fclomlar, gomlar ile hemen hemen ayn\u0131 belirtileri verir. Ay\u0131r\u0131c\u0131 tan\u0131da dolayl\u0131 \u00f6l\u00e7\u00fctlerden yararlan\u0131l\u0131r. Ba\u015fka b\u00f6lgeler\u00adde \u00f6nceden irinli odaklar bulunmas\u0131 (\u00f6rne\u011fin, irinli kulak iltihab\u0131 olgular\u0131nda Apse genellikle \u015fakak lobunda ya da beyinciktedir) ve genel enfeksiyon be\u00adlirtileri (hafif ate\u015f, Akyuvar say\u0131s\u0131n\u0131n ve kan sedimantasyon h\u0131z\u0131n\u0131n artmas\u0131) be\u00adyin apsesini d\u00fc\u015f\u00fcnd\u00fcr\u00fcr. Ba\u015fka organ\u00adlarda ayn\u0131 yap\u0131da kistlerin bulunmas\u0131; ekinokoklarda casoni deri i\u00e7i tepkime testinin Pozitif sonu\u00e7 vermesi; beyin sistiserkozunda ise kanda ve beyin-omurilik s\u0131v\u0131s\u0131nda eozinofillerin (bir akyuvar t\u00fcr\u00fc) artmas\u0131 gibi belirtiler asalaklann neden oldu\u011fu beyin apselerini g\u00f6sterir. Gom ve t\u00fcberk\u00fclomlar klinik olarak t\u00fcm\u00f6rlerden ay\u0131rt edilebilir: Has\u00adtan\u0131n \u00f6yk\u00fcs\u00fcnde ba\u015fka organlarda da t\u00fcberk\u00fcllerin bulunmas\u0131, frengi testleri\u00adnin (Wassermann, VDRL) pozitif olma\u00ads\u0131, ay\u0131r\u0131c\u0131 tan\u0131ya yard\u0131mc\u0131 olur.<\/p>\n
KOMPL\u0130KASYONLAR<\/p>\n
Beyin t\u00fcm\u00f6rlerinin kafatas\u0131 d\u0131\u015f\u0131na ya\u00ady\u0131ld\u0131klar\u0131 olgular \u00e7ok azd\u0131r. Klinik gi\u00addi\u015fleri baz\u0131 biyolojik \u00f6zellikleriyle ili\u015f\u00adkilidir. Bu \u00f6zellikler \u015f\u00f6yle s\u0131ralanabilir:<\/p>\n
T\u00fcm\u00f6r\u00fcn, bask\u0131 yapmas\u0131na uygun ol\u00admayan, Bas\u0131nc\u0131 de\u011fi\u015fmeyen bir bo\u015fluk\u00adta yer alan bir organ\u0131n \u00e7evresinde olu\u00ad\u015fup yay\u0131lmas\u0131; Duyarl\u0131 yap\u0131lara bask\u0131 yapma olas\u0131l\u0131\u011f\u0131; Etkili tedavi y\u00f6ntemle\u00adrinin uygulanmas\u0131ndaki g\u00fc\u00e7l\u00fck. Birle\u00ad\u015fik tedavi y\u00f6ntemleriyle elde edilen ba\u00adz\u0131 ba\u015far\u0131lara kar\u015f\u0131n, k\u00f6t\u00fc huylu beyin t\u00fcm\u00f6rlerinin gidi\u015fi \u00f6l\u00fcmc\u00fcld\u00fcr (hastala\u00adr\u0131n y\u00fczde 10\u2032dan az\u0131 5 y\u0131l ya\u015far). Gidi\u00ad\u015fin bu kadar k\u00f6t\u00fc olmas\u0131 t\u00fcm\u00f6r\u00fcn kafa\u00adi\u00e7i olu\u015fumlar d\u00fczeyindeki etkilerinden kaynaklan\u0131r; bu etkiler bazen yeterince denetlenemez ve s\u00fcrekli kafai\u00e7i bas\u0131n\u00e7 artmas\u0131 komaya ve \u00f6l\u00fcme neden olur. Cerrahi giri\u015fimlerin, \u0131\u015f\u0131n ve ila\u00e7 tedavi\u00adlerinin sonucunda da ayn\u0131 \u00f6l\u00e7\u00fcde \u00f6nemli, komplikasyonlar da g\u00f6r\u00fclebilir.<\/p>\n
TEDAV\u0130<\/p>\n
Genel ilkeler;<\/p>\n
Bug\u00fcne de\u011fin uygu\u00adlanan t\u00fcm tedavi giri\u015fimleri sonu\u00e7suz kalm\u0131\u015ft\u0131r; bu nedenle beyin t\u00fcm\u00f6rleri ve \u00f6zellikle k\u00f6t\u00fc huylu gliomlar (sinir sis\u00adtemi destek doku h\u00fccrelerinde geli\u015fen t\u00fcm\u00f6r) \u00f6l\u00fcmc\u00fcl kabul edilirler. T\u00fcm\u00f6\u00adr\u00fcn yeri genellikle cerrahi giri\u015fimin bazen ek\u00adsik kalmas\u0131na neden olur (bu da bir ba\u00ad\u015far\u0131s\u0131zl\u0131k nedeni kabul edilir). Sinir do\u00adkusunun yenilenme yetene\u011fi olmad\u0131\u011f\u0131n\u00addan, sa\u011fl\u0131kl\u0131 b\u00f6lgelerin al\u0131nmas\u0131, o b\u00f6l\u00adgenin i\u015flevsel \u00f6nemiyle orant\u0131l\u0131 bozuk\u00adluklara yol a\u00e7ar; a\u011f\u0131r ve kal\u0131c\u0131 sinir sis\u00adteminde, yeti yitimi ortaya \u00e7\u0131kar. T\u00fcm\u00f6r k\u00fctlesinin bulundu\u011fu yerde birbirinden farkl\u0131 \u00fc\u00e7 b\u00f6lge saptan\u0131r. En d\u0131\u015fta oda\u011f\u0131n etraf\u0131ndaki \u00f6dem b\u00f6lgesi bulunur; bura\u00adda sa\u011fl\u0131kl\u0131 beyin dokusuna yay\u0131lm\u0131\u015f du\u00adrumda ve h\u0131zla geli\u015fen k\u00fc\u00e7\u00fck t\u00fcm\u00f6r odaklar\u0131 vard\u0131r. Birinci ve \u00fc\u00e7\u00fcnc\u00fc b\u00f6l\u00adgeler aras\u0131ndaki ikinci b\u00f6lge aktif ola\u00adrak geli\u015fen bir dizi h\u00fccreden olu\u015fur. T\u00fc\u00adm\u00f6r\u00fcn ortas\u0131nda yer alan \u00fc\u00e7\u00fcnc\u00fc b\u00f6lge, doku \u00f6l\u00fcm\u00fc ve h\u00fccre y\u0131k\u0131m\u0131 b\u00f6lgesidir. T\u00fcm\u00f6r\u00fcn \u00e7evresindeki sa\u011fl\u0131kl\u0131 dokuyu alma olanaklar\u0131 olduk\u00e7a s\u0131n\u0131rl\u0131 olan cer\u00adrah, \u00f6lm\u00fc\u015f ve \u00fcremeyen b\u00f6lgeyi b\u00fct\u00fc\u00adn\u00fcyle alabilir, ama \u00fcreme durumundaki b\u00f6lgenin b\u00fcy\u00fck \u00f6l\u00e7\u00fcde b\u0131rak\u0131lmas\u0131 zo\u00adrunludur (t\u00fcm\u00f6r\u00fcn yinelenmesine yol a\u00e7an bu durum cerrahi giri\u015fimin ba\u015far\u0131\u00ads\u0131zl\u0131\u011f\u0131n\u0131n biyolojik nedeni olarak kabul edilir).<\/p>\n
Cerrahi tedavi; T\u00fcm\u00f6r\u00fcn radikal bir \u015fekilde \u00e7\u0131kar\u0131lmas\u0131 g\u00fc\u00e7t\u00fcr, ama bir b\u00f6l\u00fcm\u00fcn\u00fcn al\u0131nmas\u0131 da hastay\u0131 \u00f6nemli \u00f6l\u00e7\u00fcde rahatlat\u0131r. Cerrahi giri\u015fim y\u00f6nte\u00admi kafatas\u0131 duvar\u0131nda bir delik a\u00e7mak kadar basit ya da kraniyotomi (kafatas\u0131\u00adn\u0131n cerrahi giri\u015fimle a\u00e7\u0131lmas\u0131) gibi kar\u00adma\u015f\u0131k bir y\u00f6ntem olabilir. Basit y\u00f6n\u00adtemle yaln\u0131z t\u00fcm\u00f6r\u00fcn ya da beyin kabu\u00ad\u011funun k\u00fc\u00e7\u00fck bir b\u00f6l\u00fcm\u00fcn\u00fcn biyopsi amac\u0131yla g\u00f6r\u00fclmesi sa\u011flan\u0131r. Kraniyoto\u00admi y\u00f6ntemi ise t\u00fcm\u00f6r\u00fcn b\u00fct\u00fcn\u00fcyle \u00e7\u0131kar\u0131lmas\u0131na y\u00f6nelik geni\u015f olanaklar sa\u011f\u00adlar. B\u00fct\u00fcn\u00fcyle \u00e7\u0131kar\u0131lmas\u0131 olanaks\u0131z k\u00f6t\u00fc huylu beyin t\u00fcm\u00f6rlerinin tedavisinde te\u00admel hedeflerden biri t\u00fcm\u00f6r\u00fcn tamam\u0131na yak\u0131n oranda \u00e7\u0131kar\u0131lmas\u0131d\u0131r. Bazen bu ba\u015far\u0131lamamaktad\u0131r. Bu durum cerrahi ba\u015far\u0131ya ba\u011fl\u0131 oldu\u011fu gibi t\u00fcm\u00f6r\u00fcn yerle\u015fim yerine ve tipine g\u00f6re de de\u011fi\u015fir.<\/p>\n
I\u015f\u0131n tedavisi (radyoterapi); Gele\u00adneksel bir tedavi y\u00f6ntemi olarak kabul edilmekle birlikte, ne \u00f6l\u00e7\u00fcde etkili ol\u00addu\u011fu tam olarak belirgin de\u011fildir. Sa\u011f\u00adl\u0131kl\u0131 beyin dokusuna kal\u0131c\u0131 zarar verme\u00adden, y\u00fcksek dozda \u0131\u015f\u0131n verilmesi g\u00fcn\u00fc\u00adm\u00fczde de olduk\u00e7a g\u00fc\u00e7 bir teknik soru\u00adnudur. Bug\u00fcnk\u00fc tekniklerle radyoterapideki geli\u015fmelerle k\u0131smen de olsa \u00e7ok iyi neticeler al\u0131nmaktad\u0131r.(gama b\u0131\u00e7a\u011f\u0131).<\/p>\n
\u0130la\u00e7 tedavisi (Kemoterapi); \u0130la\u00e7 te\u00addavisine iyi yan\u0131t vermeyen \u00f6teki kat\u0131 k\u00fctleli t\u00fcm\u00f6rlerde oldu\u011fu gibi, beyin t\u00fcm\u00f6rlerinin baz\u0131 tiplerinde(oligodendriogliom) genetik bilimin \u0131\u015f\u0131\u011f\u0131nda iyi neticeler vermektedir. Cerrahi giri\u00ad\u015fim ve \u0131\u015f\u0131n tedavileri sonras\u0131nda yal\u00adn\u0131zca bir \u00f6nlem olarak uyguland\u0131\u011f\u0131 hal\u00adde, ila\u00e7 tedavisi \u0131\u015f\u0131n tedavisine oranla beklenen ya\u015fam s\u00fcresini ve yineleme s\u00fcresini \u00e7ok az uzatm\u0131\u015ft\u0131r. Yaln\u0131z son zamanlarda bulunan yeni kemoterapatik ila\u00e7lar genetik bilimin \u0131\u015f\u0131\u011f\u0131nda \u00e7ok iyi neticeler al\u0131nd\u0131\u011f\u0131 bildirilmektedir.\u00a0<\/p>\n
Son zamanlarda gen terapisi ilgili \u00e7al\u0131\u015fmalar \u00e7ok cesaret verici olup, yeni \u00e7al\u0131\u015fmalar devam etmektedir. \u0130leride kullan\u0131m\u0131 \u00e7ok yayg\u0131nla\u015fmas\u0131 muhtemeldir.\u00a0 G\u00fcn\u00fcm\u00fczde kullan\u0131m\u0131 pahal\u0131d\u0131r.\u00a0<\/p>\n
Birle\u015fik tedavi; Birle\u015fik tedavi de\u00adneyimleri, kat\u0131 k\u00fctleli t\u00fcm\u00f6rlerin tedavi\u00adsinde cerrahi ve \u0131\u015f\u0131n tedavilerinin birlik\u00adte uygulanmas\u0131n\u0131n en etkili y\u00f6ntem ol\u00addu\u011funu g\u00f6stermi\u015ftir. Beyin t\u00fcm\u00f6rleri ve \u00f6zellikle k\u00f6t\u00fc huylu gliom olgular\u0131n\u00adda, \u0131\u015f\u0131n tedavisiyle birlikte ya da tek ba\u015f\u0131na cerrahi tedavinin uygulanmas\u0131yla, ancak baz\u0131 belirtileri gidermeye y\u00f6nelik sonu\u00e7lar elde edilebilmi\u015ftir. \u00dc\u00e7 tedavi y\u00f6nteminin birlikte uygulanmas\u0131 (cerra\u00adhi giri\u015fim, \u0131\u015f\u0131n ve ila\u00e7 tedavisi) beyin t\u00fcm\u00f6r\u00fc olgular\u0131nda beklenen ya\u015fam s\u00fc\u00adresini biraz daha uzatmakta, hastan\u0131n bu s\u00fcreyi, g\u00f6rece rahat ge\u00e7irmesini sa\u011fla\u00admaktad\u0131r. \u00a0<\/p>\n
Tedavinin Komplikasyonlar\u0131<\/p>\n
1- Cerrahi; Cerrahi giri\u015fimin \u00f6l\u00fcmle so\u00adnu\u00e7lanmas\u0131 t\u00fcm\u00f6r\u00fcn t\u00fcr\u00fcne, hastan\u0131n ameliyattan \u00f6nceki n\u00f6rolojik durumuna, t\u00fcm\u00f6r\u00fcn b\u00fcy\u00fckl\u00fc\u011f\u00fcne ve yerine g\u00f6re de\u011fi\u015fir. \u00d6teki kompli\u00adkasyonlar ise \u015funlard\u0131r:<\/p>\n
Giri\u015fimden bir\u00adka\u00e7 Saat sonra ortaya \u00e7\u0131kan Ameliyat sonras\u0131 p\u0131ht\u0131 k\u00fctlesi olu\u015fumu ile kana\u00admalar;\u00f6dem ve enfeksiyon geli\u015fimit\u00fc\u00adm\u00f6r\u00fcn yerine ve kesilip \u00e7\u0131kar\u0131lan doku\u00adnun geni\u015fli\u011fine ba\u011fl\u0131 olarak, t\u00fcm\u00f6r\u00fcn \u00e7evresindeki sa\u011fl\u0131kl\u0131 dokular\u0131n bozul\u00admas\u0131 nedeniyle, kal\u0131c\u0131 ya da ge\u00e7ici sinir sistemi yetersizlik belirtileri.Hastan\u0131n iyile\u015fme s\u00fcrecinde beyine v\u00fccudunun herhangi bir yerinden p\u0131ht\u0131 atma<\/p>\n
2- I\u015f\u0131n tedavisi (radyoterapi). \u00d6zenle yap\u0131lan \u0131\u015f\u0131n tedavisinin yararlar\u0131 sa\u011fl\u0131kl\u0131 dokulara verilen zarardan \u00e7ok olsa da, iyonize \u0131\u015f\u0131nlar\u0131n sinir dokusu \u00fcze\u00adrindeki sinir sistemini zedeleyici etkile\u00adri unutulmamal\u0131d\u0131r. Erken ortaya \u00e7\u0131kan ve genellikle ge\u00ad\u00e7ici de\u011fi\u015fiklikler olabilir. \u00d6te yandan, baz\u0131 de\u011fi\u015fiklikler ge\u00e7 g\u00f6r\u00fcl\u00fcr ve kal\u0131c\u0131\u00add\u0131r. Erken de\u011fi\u015fiklikler kendili\u011finden d\u00fczelebilir ve kortizon grubu ila\u00e7 teda\u00advisinden yarar g\u00f6rebilirler. Ama ge\u00e7 de\u011fi\u015fikliklerin gidi\u015fi k\u00f6t\u00fcd\u00fcr ve tedavi\u00adleri olanaks\u0131zd\u0131r. I\u015f\u0131n tedavisi s\u0131ras\u0131nda kortizon grubu ila\u00e7 verilmesi \u00f6nerilir.<\/p>\n
3- Destek tedavisi; Beyin t\u00fcm\u00f6rlerinin birle\u015fik tedavilerinde uygulan\u0131r. Destek tedavisi, t\u00fcm\u00f6r odaklar\u0131 \u00e7evresindeki \u00f6demi ve t\u00fcm\u00f6r\u00fcn k\u00fctle etkisi sonucun\u00adda geli\u015fen kafai\u00e7i bas\u0131n\u00e7 art\u0131\u015f\u0131n\u0131 denet\u00adlemeye y\u00f6neliktir. T\u0131kay\u0131c\u0131 temelde ge\u00adli\u015fen i\u00e7 hidrosefali ve \u00e7\u0131rp\u0131nma n\u00f6betle\u00adri de ayn\u0131 etkiye ba\u011flanabilir. \u00d6nerilen tedaviler t\u0131bbi ve\/ya da cerrahidir. T\u0131bbi tedavide kortikosteroit grubu ila\u00e7lar, s\u0131\u00adv\u0131 yitirtici ozmotik ajanlar ve idrar s\u00f6kt\u00fcr\u00fcc\u00fcler kullan\u0131l\u0131r.<\/p>\n
4- Rehabilitasyon tedavisi; Beyin t\u00fc\u00adm\u00f6r\u00fc olgular\u0131n\u0131n genel tedavisinde ol\u00adduk\u00e7a \u00f6nemli bir yeri vard\u0131r. Birle\u015fik tedavilerle beklenen ya\u015fam s\u00fcresi uza\u00adt\u0131labilir; ama hastan\u0131n ya\u015fam\u0131n\u0131 olabil\u00addi\u011fince rahatlatmak da gerekir. T\u00fcm\u00f6\u00adr\u00fcn neden oldu\u011fu ve cerrahi giri\u015fim sonucu olu\u015fan lezyonlara ba\u011fl\u0131 eksik\u00adlikler \u00e7ok \u015fiddetli ve ya\u015fam\u0131 tehdit edi\u00adci olabilir. Uygun rehabilitasyon teda\u00advileri ile, bir\u00e7ok eksiklik k\u0131smen ya da b\u00fct\u00fcn\u00fcyle iyile\u015ftirilebilir. Sonu\u00e7ta zi\u00adhinsel ya da hareketlerle ilgili yeteneklerde yeterli bir iyile\u015fme elde edilebi\u00adlir.<\/p>\n
G\u0130D\u0130\u015eAT (PROGNOZ)<\/p>\n
\u0130yi huylu beyin t\u00fcm\u00f6rlerinin gidi\u015fi \u00e7o\u011funlukla iyi oldu\u011fu bilinmekle beraber beklenen ya\u015fam s\u00fcreci her zaman belir\u00adgin de\u011fildir. K\u00f6t\u00fc huylu gliyomlarda, cerrahi ve \u0131\u015f\u0131n tedavisindeki geli\u015fmele\u00adre, yeni kemoterapik ila\u00e7lar\u0131n kullan\u0131\u00adm\u0131na ve birle\u015fik tedavilere kar\u015f\u0131n, s\u00fcre\u00adcin sonu k\u00f6t\u00fcd\u00fcr; bu olgular en ge\u00e7 iki y\u0131l i\u00e7inde \u00f6l\u00fcmle sonlan\u0131r. Tek ba\u015f\u0131na cerrahi tedavi 3-6 ayl\u0131k bir ya\u015fam s\u00fcresi sa\u011flar, \u0131\u015f\u0131n tedavisinin eklenmesi s\u00fc\u00adreyi 3-4 Ay daha uzat\u0131r; bu iki tedaviye ila\u00e7 tedavisinin eklenmesiyle ger\u00e7ekle\u00ad\u015fen \u00fc\u00e7l\u00fc tedavi ortalama ya\u015fam s\u00fcresini 12 ay ya da daha \u00e7ok uzatabilir. K\u00f6t\u00fc huylu gliyom olgular\u0131nda birinci y\u0131l\u0131n sonunda hastalar\u0131n yaln\u0131zca y\u00fczde 20’si; 24\u2032\u00fcnc\u00fc ay\u0131n sonunda ise yaln\u0131zca y\u00fczde 10\u2032u ya\u015far. Gelecekte yeni y\u00f6n\u00adtemlerin bulunmas\u0131 ve\/ya da var olan\u00adlar\u0131n geli\u015ftirilmesiyle daha iyi sonu\u00e7lar elde edilmesi umulmaktad\u0131r. Medulloblastom gibi t\u00fcm\u00f6rlerde ise, tedavi sonu\u00e7lar\u0131n\u0131n de\u011ferlendirilmesi, hasta\u00adn\u0131n zaman i\u00e7inde uzun s\u00fcre kontrol alt\u0131nda tutulmas\u0131n\u0131 gerektirir. \u00c7\u00fcnk\u00fc t\u00fcm\u00f6r\u00fcn yeniden alevlenmesi ve yay\u0131l\u0131m odaklar\u0131 uzun d\u00f6nemde, \u00f6rne\u011fin ilk uygulanan tedavi\u00adden 7-10 y\u0131l sonra, ortaya \u00e7\u0131kabilir. Medulloblastom olgular\u0131nda, tedavi giri\u00ad\u015fimlerine kar\u015f\u0131n, hasta 2 ya\u015f\u0131ndan k\u00fc\u00ad\u00e7\u00fckse, t\u00fcm\u00f6r beyin sap\u0131n\u0131 tutmu\u015fsa ve t\u00fcm\u00f6r\u00fcn al\u0131nmas\u0131 k\u0131smiyse hastal\u0131\u011f\u0131n beklenen gidi\u015fi k\u00f6t\u00fcd\u00fcr. G\u00fcn\u00fcm\u00fczde kullan\u0131lan birle\u015fik tedavi y\u00f6ntemleri ol\u00adgular\u0131n yakla\u015f\u0131k y\u00fczde 60\u2032\u0131nda 5 y\u0131ll\u0131k bir ya\u015fam s\u00fcresi sa\u011flar. Tedavinin etki\u00adsini klinik d\u00fczeyde de\u011ferlendirmek zor\u00addur. Bir\u00e7ok sinirsel yetenek yitimi kal\u0131\u00adc\u0131d\u0131r, t\u00fcm\u00f6r iyile\u015fse bile bunlar ge\u00e7\u00admez. Hastan\u0131n k\u00f6t\u00fcle\u015fmesi t\u00fcm\u00f6r\u00fcn ye\u00adniden geli\u015fmeye ba\u015flamas\u0131na de\u011fil, \u0131\u015f\u0131n tedavisi sonras\u0131 ortaya \u00e7\u0131kan \u00f6dem ya da hidrosefaliye (beyin kar\u0131nc\u0131klar\u0131nda a\u015f\u0131r\u0131 beyin-omurilik s\u0131v\u0131s\u0131 birikmesi) ba\u011fl\u0131d\u0131r. Tedavinin etkisini de\u011ferlendirmede en iyi \u00f6l\u00e7\u00fct, beklenen ya\u015fam s\u00fcresidir. Son on y\u0131lda Anestezi ve cerrahi tekniklerindeki iyile\u015fmeye, baz\u0131 \u0131\u015f\u0131n tedavisi ara\u00e7lar\u0131n\u0131n kusursuzla\u015fmas\u0131na ve t\u00fcm\u00f6r geli\u015fmesini \u00f6nleyici yeni ve etkili ila\u00e7\u00adlar\u0131n bulunmas\u0131na kar\u015f\u0131n, k\u00f6t\u00fc huylu beyin t\u00fcm\u00f6rlerinde beklenen ya\u015fam s\u00fc\u00adresi, ne yaz\u0131k ki, uzat\u0131lamam\u0131\u015ft\u0131r.<\/p>\n
HAZIRLAYAN; Dr. Turgay B\u0130LGE<\/p>\n","protected":false},"excerpt":{"rendered":"
Beyin t\u00fcm\u00f6rlerinin g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 100 bin ki\u015fide 3,8 ile 5,1 aras\u0131nda de\u011fi\u015fir. Kansere ba\u011fl\u0131 \u00f6l\u00fcmlerin y\u00fczde 2,7’si beyin t\u00fcm\u00f6rlerinin sonucudur; \u00f6l\u00fcm endeksi her 100 bin ki\u015fide, erkeklerde 3,3, kad\u0131nlarda ise 2,3\u2032t\u00fcr. Beyin t\u00fc\u00adm\u00f6rleri \u00e7ocukluk \u00e7a\u011f\u0131nda kan kanser\u00adleri ve k\u00f6t\u00fc huylu lenfomlardan sonra en s\u0131k g\u00f6r\u00fclen t\u00fcm\u00f6r grubunu olu\u015ftu\u00adrur; bu ya\u015flarda rastlanan k\u00f6t\u00fc huylu t\u00fcm\u00f6rlerin y\u00fczde 20-25\u2032i beyin t\u00fcm\u00f6r\u00adleridir. Travma, vir\u00fcs,[Devam\u0131n\u0131 Oku…]<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[22524],"tags":[23069,23072,23074,23070,23068,23067,23071,23073],"_links":{"self":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13199"}],"collection":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/comments?post=13199"}],"version-history":[{"count":0,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13199\/revisions"}],"wp:attachment":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/media?parent=13199"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/categories?post=13199"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/tags?post=13199"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}