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Published on: July 28, 2018
Third Ventricle Volume Predicts Functional Outcome in Chronic Subdural Hematoma
Rafael Martinez-Perez1,2, Michael W Kortz1, Timothy H Ung1
1Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA.
Insights
Computed tomography (CT) can predict chronic subdural hematoma (CSH) outcomes. Greater preoperative third ventricle volume (3VV) on CT scans indicates a higher risk of poor functional outcomes after surgery.
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Chronic subdural hematoma (CSDH) management lacks predictive tools for clinical outcomes.
- Computed tomography (CT) is crucial for CSDH diagnosis but its predictive utility for outcomes is understudied.
Purpose of the Study:
- To evaluate the role of tomographic volumetric analysis in predicting clinical outcomes for CSDH patients.
- To determine if preoperative CT measurements can forecast functional recovery after CSDH treatment.
Main Methods:
- Retrospective analysis of 79 CSDH patients undergoing burr-hole craniostomy (BHC).
- Preoperative CT scans were analyzed for midline shift, hematoma volume, and ventricle volumes (3VV, 4VV) using semiautomatic segmentation.
- Postoperative outcomes assessed by NIHSS at discharge and mRS at 6 weeks.
Main Results:
- Increased preoperative third ventricle volume (3VV) significantly correlated with poor NIHSS at discharge (p=.01) and 6-week mRS (p=.03).
- A 3VV threshold of 0.545 mL showed high sensitivity (77.1%) and specificity (88.8%) for predicting functional dependence.
- Elevated 3VV was a strong independent predictor of poor functional outcome (OR 9.29, p=.001).
Conclusions:
- Preoperative tomographic third ventricle volume (3VV) is an independent prognostic factor for CSDH patient outcomes.
- A 3VV threshold of 0.545 mL can identify patients at higher risk of dependency post-treatment, aiding clinical decision-making.
Objectives:
There is a lack of evidence demonstrating the utility of computed tomography (CT) to predict chronic subdural hematoma (CSDH) clinical outcomes. We aim to analyze the role of tomographic volumetric analysis in patients with CSDH.
Methods:
We performed a retrospective study of patients undergoing burr-hole craniostomy (BHC) for CSDH over five years at a tertiary care center. Degree of midline shift, radiographic density, subdural hematoma volume, acute blood volume, and third ventricle (3VV) and fourth ventricle (4VV) volume were estimated using semiautomatic segmentation of preoperative CT. Postoperative functional outcome was measured by two endpoints: National Institute of Health Stroke Scale (NIHSS) at discharge and short-term modified Rankin Scale (mRS) at 6-week follow-up. Univariate and multivariate analyses were performed using nonparametric tests. Discriminative capacity and optimal thresholds of independent variables were calculated by means of receiving-operative curves (ROC).
Results:
A total of 79 patients were included for analysis with a median age of 78.5 years. Greater preoperative 3VV independently correlated with poor discharge NIHSS (p = .01) and short-term mRS (p = .03). A cutoff value of 0.545 mL demonstrated the highest sensitivity (77.1%) and specificity (88.8%) with an odds ratio for an mRS functional dependence of 9.29 (p = .001).
Conclusions:
Greater preoperative tomographic 3VV independently prognosticates poor discharge NIHSS and 6-week mRS. A threshold 3VV of 0.545 mL can be used to identify patients at higher risk of being dependent at first protocolized follow-up.
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