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Preoperative Head CT Assisted Prediction of Acute Encephalocele During Isolated Acute Subdural Hematoma Surgery

Received: 8 October 2021    Accepted: 2 November 2021    Published: 17 November 2021
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Abstract

To investigate more predictors for acute encephalocele in patients during isolated acute subdural hematoma (ASDH) surgery by using clinical data combined with preoperative cranial computed tomography (CT) scan, so as to provide a basis for the development of a more scientific and reasonable treatment strategy. CT images and medical records of 46 patients who underwent neurosurgery for isolated traumatic acute subdural hematoma were collected. The patients with intra-operative acute encephalocele were grouped as the observation group (n=23), and the patients with no intra-operative acute encephalocele, whose age difference was within 5 years were included in the control group (n=23). The t-test and multivariate logistic regression analyses were carried out to evaluate the influence of clinical variables on acute encephalocele. Meanwhile, whether differences among Thickness of hematoma(TH), Midline shift (MLS), Hounsfield units of white matter (HU-WM), Hounsfield units of hematoma (HU-HT) and basal cistern effaced score (CES) measured by cranial CT could be used as predictors of outcomes in patients with acute encephalocele during subdural hematoma surgery was evaluated. There were no significant differences in age, sex, mechanism of injury, the time from trauma to decompression, and the MLS during surgery between the two groups. However, significant differences in preoperative Glasgow Coma Score (GCS), TH, HU-WM and HU-HT between the two groups were observed. The multivariate logistic regression analysis of radiographic data showed that HU-WM and CES were independent risk factors and strong predictors for intra-operative acute encephalocele. The areas under curve of CES and HU-WM were 0.8459 and 0.8336, respectively. The risk factors for acute encephalocele during ASDH operation are identified in this study. An increased risk of intra-operative acute encephalocele is found in patients with lower preoperative GCS, HU-WM, HU-HT and higher preoperative TH and CES, which should help clinicians to develop a more scientific treatment strategy and improve the survival of such kind of patients.

Published in International Journal of Neurosurgery (Volume 5, Issue 2)
DOI 10.11648/j.ijn.20210502.16
Page(s) 84-89
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Acute Subdural Hematoma, Intra-operative Acute Encephalocele, Hounsfield Units, White Matter

References
[1] Nagahiro S, Mizobuchi Y. Current topics in sports-related head injuries: a review. Neurol Med Chir (Tokyo) 54: 878-886, 2014.
[2] Miller JD, Nader R. Acute subdural hematoma from bridging vein rupture: a potential mechanism for growth. Journal of neurosurgery 120:1378-1384, 2014.
[3] Bartek J, Jr., Laugesen C, Mirza S, Forsse A, Petersen MA, Corell A, et al. Scandinavian Multicenter Acute Subdural Hematoma (SMASH) Study: Study Protocol for a Multinational Population-Based Consecutive Cohort. Neurosurgery 84: 799-803, 2019.
[4] Artru F JC, Convert J, Duquesnel J, Deleuze R, et al. An Effacement Score for Basal Cisterns to Predict ICP Level and Outcome After Severe Closed Head Injury. Intracranial Pressure VII Springer, Berlin, Heidelberg 603-604, 1989.
[5] Bartels RH, Meijer FJ, van der Hoeven H, Edwards M, Prokop M. Midline shift in relation to thickness of traumatic acute subdural hematoma predicts mortality. BMC neurology 15: 220, 2015.
[6] Shen J, Fan Z, Ji T, Pan J, Zhou Y, Zhan R. Contralateral acute subdural hematoma following traumatic acute subdural hematoma evacuation. Neurol Med Chir (Tokyo) 53: 221-224, 2013.
[7] Arslan E, Arslan S, Kalkisim S, Arslan A, Kuzeyli K. Long-Term Results of Orbital Roof Repair with Titanium Mesh in a Case of Traumatic Intraorbital Encephalocele: A Case Report and Review of Literature. Craniomaxillofacial trauma & reconstruction 9:.255-259, 2016.
[8] Leitgeb J, Mauritz W, Brazinova A, Janciak I, Majdan M, Wilbacher I, et al. Outcome after severe brain trauma due to acute subdural hematoma. Journal of neurosurgery 117: 324-333, 2012.
[9] Zumkeller M, Behrmann R, Heissler HE, Dietz H. Computed tomographic criteria and survival rate for patients with acute subdural hematoma. Neurosurgery 39 (4): 708-12, 1996.
[10] Yanaka K, Kamezaki T, Yamada T, Takano S, Meguro K, Nose T. Acute subdural hematoma--prediction of outcome with a linear discriminant function. Neurol Med Chir (Tokyo) 33: 552-558, 1993.
[11] Wang Z, Guo S, Wang J, Shen Y, Zhang J, Wu Q. Nrf2/HO-1 mediates the neuroprotective effect of mangiferin on early brain injury after subarachnoid hemorrhage by attenuating mitochondria-related apoptosis and neuroinflammation. Scientific reports 7: 11883, 2017.
[12] Diedler J, Sykora M, Hahn P, Heerlein K, Scholzke MN, Kellert L, et al. Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage. Critical care 14: 63, 2010.
[13] Karibe H, Hayashi T, Hirano T, Kameyama M, Nakagawa A, Tominaga T. Surgical management of traumatic acute subdural hematoma in adults: a review. Neurol Med Chir (Tokyo) 54: 887-894, 2014.
[14] Phan K, Moore JM, Griessenauer C, Dmytriw AA, Scherman DB, Sheik-Ali S, et al. Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis. World neurosurgery 101: 677-685, 2017.
[15] Moussa WMM, Khedr WM, Elwany AH. Prognostic significance of hematoma thickness to midline shift ratio in patients with acute intracranial subdural hematoma: a retrospective study. Neurosurgical review 41: 483-488, 2018.
[16] Jayakumar AR, Taherian M, Panickar KS, Shamaladevi N, Rodriguez ME, Price BG, et al. Differential Response of Neural Cells to Trauma-Induced Swelling In Vitro. Neurochemical research 43: 397-406, 2018.
[17] Mestre H, Du T, Sweeney AM, Liu G, Samson AJ, Peng W, et al. Cerebrospinal fluid influx drives acute ischemic tissue swelling. Science 367: 6483, 2020.
[18] von Holst H, Li X, Kleiven S. Increased strain levels and water content in brain tissue after decompressive craniotomy. Acta neurochirurgica 154: 1583-1593, 2012.
[19] Yamamura H, Morioka T, Yamamoto T, Mizobata Y. Head computed tomographic measurement as a predictor of outcome in patients with subdural hematoma with cerebral edema. Scandinavian journal of trauma, resuscitation and emergency medicine 24: 83, 2016.
[20] Saito T, Kushi H, Makino K, Hayashi N. The risk factors for the occurrence of acute brain swelling in acute subdural hematoma. Acta neurochirurgica Supplement 86: 351-354, 2003.
[21] Yamamoto M, Orito K, Nakamura Y, Takeshige N, Yoshitomi M, Takeuchi Y, et al. Leakage sign for acute subdural hematoma in clinical treatment. Acta neurochirurgica 161: 233-238, 2019.
[22] Li Q, Zhang G, Huang YJ, Dong MX, Lv FJ, Wei X, et al. Blend Sign on Computed Tomography: Novel and Reliable Predictor for Early Hematoma Growth in Patients With Intracerebral Hemorrhage. Stroke 46: 2119-2123, 2015.
[23] Rubiano AM, Carney N, Khan AA, Ammirati M. The Role of Decompressive Craniectomy in the Context of Severe Traumatic Brain Injury: Summary of Results and Analysis of the Confidence Level of Conclusions From Systematic Reviews and Meta-Analyses. Frontiers in neurology 10: 1063, 2019.
[24] Honeybul S. Decompressive craniectomy for severe traumatic brain injury reduces mortality but increases survival with severe disability. Evidence-based medicine 22: 61, 2017.
[25] Akbik OS, Starling RV, Gahramanov S, Zhu Y, Lewis J. Mortality and Functional Outcome in Surgically Evacuated Acute Subdural Hematoma in Elderly Patients. World neurosurgery 126: 1235-1241, 2019.
Cite This Article
  • APA Style

    Jiandong Wu, Gang Wu, Xiao-Yu Tang, Peng Deng, Jin-hong Qian, et al. (2021). Preoperative Head CT Assisted Prediction of Acute Encephalocele During Isolated Acute Subdural Hematoma Surgery. International Journal of Neurosurgery, 5(2), 84-89. https://doi.org/10.11648/j.ijn.20210502.16

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    ACS Style

    Jiandong Wu; Gang Wu; Xiao-Yu Tang; Peng Deng; Jin-hong Qian, et al. Preoperative Head CT Assisted Prediction of Acute Encephalocele During Isolated Acute Subdural Hematoma Surgery. Int. J. Neurosurg. 2021, 5(2), 84-89. doi: 10.11648/j.ijn.20210502.16

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    AMA Style

    Jiandong Wu, Gang Wu, Xiao-Yu Tang, Peng Deng, Jin-hong Qian, et al. Preoperative Head CT Assisted Prediction of Acute Encephalocele During Isolated Acute Subdural Hematoma Surgery. Int J Neurosurg. 2021;5(2):84-89. doi: 10.11648/j.ijn.20210502.16

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  • @article{10.11648/j.ijn.20210502.16,
      author = {Jiandong Wu and Gang Wu and Xiao-Yu Tang and Peng Deng and Jin-hong Qian and Zhi-Qi Cheng and Mian Ma},
      title = {Preoperative Head CT Assisted Prediction of Acute Encephalocele During Isolated Acute Subdural Hematoma Surgery},
      journal = {International Journal of Neurosurgery},
      volume = {5},
      number = {2},
      pages = {84-89},
      doi = {10.11648/j.ijn.20210502.16},
      url = {https://doi.org/10.11648/j.ijn.20210502.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20210502.16},
      abstract = {To investigate more predictors for acute encephalocele in patients during isolated acute subdural hematoma (ASDH) surgery by using clinical data combined with preoperative cranial computed tomography (CT) scan, so as to provide a basis for the development of a more scientific and reasonable treatment strategy. CT images and medical records of 46 patients who underwent neurosurgery for isolated traumatic acute subdural hematoma were collected. The patients with intra-operative acute encephalocele were grouped as the observation group (n=23), and the patients with no intra-operative acute encephalocele, whose age difference was within 5 years were included in the control group (n=23). The t-test and multivariate logistic regression analyses were carried out to evaluate the influence of clinical variables on acute encephalocele. Meanwhile, whether differences among Thickness of hematoma(TH), Midline shift (MLS), Hounsfield units of white matter (HU-WM), Hounsfield units of hematoma (HU-HT) and basal cistern effaced score (CES) measured by cranial CT could be used as predictors of outcomes in patients with acute encephalocele during subdural hematoma surgery was evaluated. There were no significant differences in age, sex, mechanism of injury, the time from trauma to decompression, and the MLS during surgery between the two groups. However, significant differences in preoperative Glasgow Coma Score (GCS), TH, HU-WM and HU-HT between the two groups were observed. The multivariate logistic regression analysis of radiographic data showed that HU-WM and CES were independent risk factors and strong predictors for intra-operative acute encephalocele. The areas under curve of CES and HU-WM were 0.8459 and 0.8336, respectively. The risk factors for acute encephalocele during ASDH operation are identified in this study. An increased risk of intra-operative acute encephalocele is found in patients with lower preoperative GCS, HU-WM, HU-HT and higher preoperative TH and CES, which should help clinicians to develop a more scientific treatment strategy and improve the survival of such kind of patients.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Preoperative Head CT Assisted Prediction of Acute Encephalocele During Isolated Acute Subdural Hematoma Surgery
    AU  - Jiandong Wu
    AU  - Gang Wu
    AU  - Xiao-Yu Tang
    AU  - Peng Deng
    AU  - Jin-hong Qian
    AU  - Zhi-Qi Cheng
    AU  - Mian Ma
    Y1  - 2021/11/17
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijn.20210502.16
    DO  - 10.11648/j.ijn.20210502.16
    T2  - International Journal of Neurosurgery
    JF  - International Journal of Neurosurgery
    JO  - International Journal of Neurosurgery
    SP  - 84
    EP  - 89
    PB  - Science Publishing Group
    SN  - 2640-1959
    UR  - https://doi.org/10.11648/j.ijn.20210502.16
    AB  - To investigate more predictors for acute encephalocele in patients during isolated acute subdural hematoma (ASDH) surgery by using clinical data combined with preoperative cranial computed tomography (CT) scan, so as to provide a basis for the development of a more scientific and reasonable treatment strategy. CT images and medical records of 46 patients who underwent neurosurgery for isolated traumatic acute subdural hematoma were collected. The patients with intra-operative acute encephalocele were grouped as the observation group (n=23), and the patients with no intra-operative acute encephalocele, whose age difference was within 5 years were included in the control group (n=23). The t-test and multivariate logistic regression analyses were carried out to evaluate the influence of clinical variables on acute encephalocele. Meanwhile, whether differences among Thickness of hematoma(TH), Midline shift (MLS), Hounsfield units of white matter (HU-WM), Hounsfield units of hematoma (HU-HT) and basal cistern effaced score (CES) measured by cranial CT could be used as predictors of outcomes in patients with acute encephalocele during subdural hematoma surgery was evaluated. There were no significant differences in age, sex, mechanism of injury, the time from trauma to decompression, and the MLS during surgery between the two groups. However, significant differences in preoperative Glasgow Coma Score (GCS), TH, HU-WM and HU-HT between the two groups were observed. The multivariate logistic regression analysis of radiographic data showed that HU-WM and CES were independent risk factors and strong predictors for intra-operative acute encephalocele. The areas under curve of CES and HU-WM were 0.8459 and 0.8336, respectively. The risk factors for acute encephalocele during ASDH operation are identified in this study. An increased risk of intra-operative acute encephalocele is found in patients with lower preoperative GCS, HU-WM, HU-HT and higher preoperative TH and CES, which should help clinicians to develop a more scientific treatment strategy and improve the survival of such kind of patients.
    VL  - 5
    IS  - 2
    ER  - 

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Author Information
  • Department of Neurosurgery, Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, China

  • Department of Neurosurgery, Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, China

  • Department of Neurosurgery, Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, China

  • Department of Neurosurgery, Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, China

  • Department of Neurosurgery, Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, China

  • Department of Neurosurgery, Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, China

  • Department of Neurosurgery, Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, China

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