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Published on: October 2, 2014
Does the skull Hounsfield unit predict shunt dependent hydrocephalus after decompressive craniectomy for traumatic
In-Suk Bae1, Jae Min Kim2, Jin Hwan Cheong2
1Department of Neurosurgery, Eulji University Eulji Hospital, Seoul, Korea.
Insights
Low skull bone density, measured by Hounsfield units (HU), may predict shunt-dependent hydrocephalus (SDHC) after decompressive craniectomy for traumatic brain injury. Specific HU values in the frontal bone and occipital protuberance identified patients at higher risk for SDHC.
Area of Science:
- Neurosurgery
- Radiology
- Trauma Surgery
Background:
- Posttraumatic hydrocephalus (SDHC) affects a significant portion of patients after decompressive craniectomy (DC) for traumatic brain injury (TBI).
- SDHC often necessitates ventriculo-peritoneal shunt placement.
- Shared collagen type between bone and arachnoid trabeculae suggests a potential link between skull bone density and hydrocephalus development.
Purpose of the Study:
- To investigate the relationship between skull Hounsfield unit (HU) values and the development of shunt-dependent hydrocephalus (SDHC).
- To identify predictive skull HU values for SDHC in patients who underwent cranioplasty after DC for traumatic acute subdural hematoma (SDH).
Main Methods:
- Measurement of frontal bone and internal occipital protuberance HU values from admission brain CT scans.
- Receiver operating characteristic (ROC) curve analysis to determine optimal cut-off HU values for SDHC prediction.
- Multivariable logistic regression analysis to identify independent predictive factors for SDHC.
Main Results:
- A total of 162 patients were analyzed over an 11-year period.
- Simultaneous frontal skull HU ≤797.4 and internal occipital protuberance HU ≤586.5 were identified as the sole independent predictor of SDHC.
- This combination showed a significant odds ratio of 8.57 (95% CI, 3.05 to 24.10; P<0.001).
Conclusions:
- Findings suggest a potential association between low bone mineral density and the development of SDHC in patients with traumatic acute SDH who underwent DC.
- Low skull bone density, indicated by specific HU values, may serve as a predictive marker for SDHC.
- This research offers insights into the link between bone density and hydrocephalus post-DC for traumatic SDH.
Background And Purpose:
Posttraumatic hydrocephalus affects 11.9%-36% of patients undergoing decompressive craniectomy (DC) after traumatic brain injury and necessitates a ventriculo-peritoneal shunt placement. As bone and arachnoid trabeculae share the same collagen type, we investigated possible connections between the skull Hounsfield unit (HU) values and shunt-dependent hydrocephalus (SDHC) in patients that received cranioplasty after DC for traumatic acute subdural hematoma (SDH).
Methods:
We measured HU values in the frontal bone and internal occipital protuberance from admission brain CT. Receiver operating characteristic curve analysis was performed to identify the optimal cut-off skull HU values for predicting SDHC in patients receiving cranioplasty after DC due to traumatic acute SDH. We investigated independent predictive factors for SDHC occurrence using multivariable logistic regression analysis.
Results:
A total of 162 patients (>15 years of age) were enrolled in the study over an 11-year period from two university hospitals. Multivariable logistic analysis revealed that the group with simultaneous frontal skull HU ≤797.4 and internal occipital protuberance HU ≤586.5 (odds ratio, 8.57; 95% CI, 3.05 to 24.10; P<0.001) was the only independent predictive factor for SDHC in patients who received cranioplasty after DC for traumatic acute SDH.
Conclusions:
Our study reveals a potential relationship between possible low bone mineral density and development of SDHC in traumatic acute SDH patients who had undergone DC. Our findings provide deeper insight into the association between low bone mineral density and hydrocephalus after DC for traumatic acute SDH.
