Novel CT-based parameters assessing relative cross-sectional area to guide surgical management and predict clinical outcomes in patients with acute subdural hematoma

Introduction Acute subdural hematoma (aSDH) is one of the most devastating entities secondary to traumatic brain injury (TBI). Even though radiological computed tomography (CT) findings, such as hematoma thickness (HT), midline shift (MLS), and MLS/HT ratio, have an important prognostic role, they s...

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Published in:Neuroradiology 2023-03, Vol.65 (3), p.489-501
Main Authors: García-Pérez, Daniel, Castaño-León, Ana M., Moreno-Gómez, Luis Miguel, Esteban-Sinovas, Olga, García-Posadas, Guillermo, Panero-Pérez, Irene, Paredes, Igor, Gómez-López, Pedro A., Lagares, Alfonso
Format: Article
Language:English
Subjects:
Blood
Brain
Brain Injuries, Traumatic
Clinical outcomes
Compression
Computed tomography
Convexity
Diagnostic Neuroradiology
Dura mater
Head injuries
Hematoma
Hematoma, Subdural, Acute - surgery
Humans
Imaging
Medicine
Medicine & Public Health
Meninges
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Parameters
Patients
Prognosis
Radiology
Retrospective Studies
Segmentation
Skull
Tomography, X-Ray Computed
Traumatic brain injury
Treatment Outcome
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Summary:Introduction Acute subdural hematoma (aSDH) is one of the most devastating entities secondary to traumatic brain injury (TBI). Even though radiological computed tomography (CT) findings, such as hematoma thickness (HT), midline shift (MLS), and MLS/HT ratio, have an important prognostic role, they suffer from important drawbacks. We hypothesized that relative cross-sectional area (rCSA) of specific brain regions would provide valuable information about brain compression and swelling, thus being a key determining factor governing the clinical course. Methods We performed an 8-year retrospective analysis of patients with moderate to severe TBI with surgically evacuated, isolated, unilateral aSDH. We investigated the influence of aSDH rCSA and ipsilateral hemisphere rCSA along the supratentorial region on the subsequent operative technique employed for aSDH evacuation and patient’s clinical outcomes (early death and Glasgow Outcome Scale [GOS] at discharge and after 1-year follow-up). Different conventional radiological variables were also assessed. Results The study included 39 patients. Lower HT, MLS, hematoma volume, and aSDH rCSA showed a significant association with decompressive craniectomy (DC) procedure. Conversely, higher ipsilateral hemisphere rCSA along the dorso-ventral axis and, specifically, ipsilateral hemisphere rCSA at the high convexity level were predictors for DC. CT segmentation analysis exhibited a modest relationship with early death, which was limited to the basal supratentorial subregion, but could not predict long-term outcome. Conclusion rCSA is an objectifiable and reliable radiologic parameter available on admission CT that might provide valuable information to optimize surgical treatment.
ISSN:0028-3940
1432-1920
DOI:10.1007/s00234-022-03087-5