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A Preclinical Controlled Cortical Impact Model for Traumatic Hemorrhage Contusion and Neuroinflammation

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New Radiologic Parameters Predict Clinical Outcome after Decompressive Craniectomy.

Thomas Sauvigny¹, Jennifer Göttsche¹, Eik Vettorazzi²

¹Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

World Neurosurgery

|November 10, 2015

Summary

Radiologic parameters predict outcomes after decompressive craniectomy. Midline shift predicts outcomes in malignant MCA infarction, while hemisphere diameter ratio predicts outcomes in traumatic brain injury.

Keywords:

CT scan Decompressive craniectomy Middle cerebral artery infarction Traumatic brain injury

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Quantifying Cognitive Decrements Caused by Cranial Radiotherapy

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Published on: October 18, 2011

Area of Science:

Neurosurgery
Radiology
Critical Care Medicine

Background:

Decompressive craniectomy (DC) is vital for managing increased intracranial pressure (ICP) from malignant middle cerebral artery (MCA) infarction and traumatic brain injury (TBI).
Identifying reliable prognostic radiologic parameters is crucial for optimizing patient outcomes after DC.

Purpose of the Study:

To identify and compare prognostic radiologic parameters for functional outcomes in patients undergoing DC for malignant MCA infarction versus TBI.
To evaluate the predictive value of changes in midline shift (ΔMLS) and hemisphere diameter ratio (HDratio) on clinical outcomes.

Main Methods:

Analysis of 113 patients' clinical courses, correlating preoperative and postoperative CT scan features with Glasgow Outcome Scale (GOS) scores.
Calculation of ΔMLS (presurgical vs. postsurgical midline shift) and HDratio (affected vs. contralateral hemisphere diameter).

Main Results:

ΔMLS showed significant predictive value for outcome in the malignant MCA infarction group (OR 0.715).
Postsurgical HDratio was a significant predictor of outcome in the TBI group (OR 0.620).
ΔMLS did not show predictive value in the TBI group.

Conclusions:

ΔMLS is a valuable, objective prognostic tool for malignant MCA infarction patients undergoing DC.
Postsurgical HDratio is a strong predictor of clinical outcome specifically in TBI patients.
Routine application of postsurgical HDratio in TBI management can aid in outcome estimation and treatment adjustment.