Sauvigny Thomas, Göttsche Jennifer, Vettorazzi Eik, Westphal Manfred, Regelsberger Jan
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
World Neurosurg. 2016 Apr;88:519-525.e1. doi: 10.1016/j.wneu.2015.10.072. Epub 2015 Nov 5.
Decompressive craniectomy (DC) is an established part of the management of patients with increased intracranial pressure due to malignant middle cerebral artery (MCA) infarction or traumatic brain injury (TBI). The aim of this study was to determine prognostic radiologic parameters regarding the functional outcome of patients with increased intracranial pressure (ICP) undergoing DC. Special focus was put on the potential differences between malignant MCA infarction and TBI.
A total of 113 patients were analyzed for their clinical course where preoperative and postoperative radiologic features in computed tomography (CT) scans were correlated to the clinical outcome assessed by the Glasgow Outcome Scale. The difference between presurgical and postsurgical midline shift (ΔMLS) and the ratio between the diameter of the affected and contralateral hemisphere (HDratio) in presurgical and postsurgical CT scans were calculated.
ΔMLS (MCA infarction group) and postsurgical HDratio (TBI group) were found to be highly correlating with the clinical outcome on Spearman-correlation testing and underwent further analysis using a binary logistic regression model to evaluate their prognostic value on the outcome, which showed the predictive power of ΔMLS in malignant MCA infarction patients (odds ratio [OR] 0.715; confidence interval [CI] 0.551-0.865). Postsurgical HDratio correlated significantly (OR 0.620; CI 0.384-0.901) with the outcome in the TBI group.
ΔMLS is an objectifiable parameter, predicting outcome in malignant MCA infarction. In contrast, ΔMLS was of no predictive value in TBI patients. Here postsurgical HDratio serves as a strong predictor of clinical outcome. We recommend applying postsurgical HDratio to TBI patients in order to estimate their clinical outcome and adjust treatment.
去骨瓣减压术（DC）是治疗因恶性大脑中动脉（MCA）梗死或创伤性脑损伤（TBI）导致颅内压升高患者的既定治疗方法。本研究的目的是确定接受DC治疗的颅内压升高（ICP）患者功能预后的预后影像学参数。特别关注恶性MCA梗死和TBI之间的潜在差异。
共分析了113例患者的临床病程，将计算机断层扫描（CT）术前和术后的影像学特征与格拉斯哥预后量表评估的临床结局相关联。计算术前和术后CT扫描中术前与术后中线移位（ΔMLS）的差异以及患侧与对侧半球直径之比（HDratio）。
在Spearman相关性检验中发现，ΔMLS（MCA梗死组）和术后HDratio（TBI组）与临床结局高度相关，并使用二元逻辑回归模型进行进一步分析，以评估它们对结局的预后价值，结果显示ΔMLS对恶性MCA梗死患者具有预测能力（比值比[OR]0.715；置信区间[CI]0.551 - 0.865）。术后HDratio与TBI组的结局显著相关（OR 0.620；CI 0.384 - 0.901）。
ΔMLS是一个可客观化的参数，可预测恶性MCA梗死的结局。相比之下，ΔMLS对TBI患者无预测价值。在此，术后HDratio是临床结局的有力预测指标。我们建议将术后HDratio应用于TBI患者，以评估其临床结局并调整治疗。
