Can midline brain shift be used as a prognostic factor to predict postoperative restoration of consciousness in patients with chronic subdural hematoma?

• Published in: Surgical neurology 2006-08, Vol.66 (2), p.178-182
• Main Authors: Sucu, Hasan Kamil, Gelal, Fazıl, Gökmen, Metin, Özer, Füsun Demirçivi, Tektaş, Şevket
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Brain - diagnostic imaging; Brain - physiopathology; Brain - surgery; Brain shift; Chronic subdural hematoma; Consciousness Disorders - diagnostic imaging; Consciousness Disorders - etiology; Consciousness Disorders - surgery; Female; Follow-Up Studies; Hematoma, Subdural, Chronic - diagnostic imaging; Hematoma, Subdural, Chronic - psychology; Hematoma, Subdural, Chronic - surgery; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Radiography; Recovery of Function; Restoration of consciousness; Treatment Outcome
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2005.12.036

Our aim was to determine if midline brain shift could be used as a prognostic factor to predict postoperative restoration of consciousness in patients with CSDH. In these patients, we evaluated the relation (1) between midline brain shift as measured on CT and alteration of level of consciousness, and (2) between midline brain shift and restoration of consciousness after the operation. Prospectively recorded data of 45 patients with CSDH were evaluated. We compared level of consciousness of patients measured by GCS score, brain displacement at PG and SP both in the preoperative and early postoperative period. Preoperatively, PG and SP shifts of the patients who were alert (GCS = 15) were significantly less than those of patients who had diminished consciousness. However, in patients with diminished consciousness (GCS < 15), the amount of lateral brain displacement and the degree of diminution of consciousness did not correlate. Those patients who had a preoperative SP shift of less than 10 mm had a significantly lesser chance to become alert after operation (2 of 5 patients) when compared with those patients who had a preoperative SP shift of 10 mm or more (21 of 23 patients). We conclude that preoperative SP shift may be used as a factor to predict restoration of consciousness in patients with CSDH; the likelihood of becoming alert after operation is increased if SP shift is 10 mm or greater, and is decreased if SP shift is less than 10 mm.