Jeong Won Joo, Bang Jae Seung, Yum Kyu Sun, Lee Sangkil, Chung Inyoung, Kwon O-Ki, Oh Chang Wan, Kim Beom Joon, Bae Hee-Joon, Han Moon-Ku
1 Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea .
2 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea .
Ther Hypothermia Temp Manag. 2018 Sep;8(3):136-142. doi: 10.1089/ther.2017.0045. Epub 2018 Feb 15.
Brain herniation is most often the result of severe brain swelling and can rapidly lead to death or brain death. We retrospectively identified radiologic indicators to evaluate the effects of targeted temperature management (TTM) on the extent of cerebral edema and determine the cutoff values that best predict TTM outcomes in patients with large hemispheric infarction. We retrospectively reviewed brain computed tomography (CT) scans of 21 patients with large hemispheric infarctions, who were treated with TTM. We excluded 4 patients whose CT scans were inadequate for evaluation, which left 17 patients. We divided the patients into success and failure groups. TTM failure was defined as death or the need for decompressive hemicraniectomy (DHC) after TTM. Infarction size was measured as the total restricted area in diffusion-weighted imaging that was performed on admission. CT scans were obtained on the first and second days after TTM initiation and then every 2 days. We measured septum pellucidum shifts (SPS) and pineal gland shifts (PGS) on CT scans. The median time from symptom onset to TTM initiation was 14.5 hours. Ten patients were successfully treated with TTM, six patients died, and one patient underwent a DHC. Initial infarction sizes were not significantly different between the success and failure groups (p = 0.529), but the SPS and PGS at 36-72 hours after TTM initiation were (mean SPS: 5.0 vs. 14.9 mm, p = 0.001; mean PGS: 2.3 vs. 7.9 mm, p = 0.001). The sensitivity and negative predictive value for TTM failure caused by cerebral edema (SPS ≥9.25 mm and PGS ≥3.70 mm) at 36-72 hours after TTM initiation were both 100%. The SPS and PGS on CT scans taken 36-72 hours after TTM initiation may help to estimate the effect of TTM on cerebral edema and guide further treatment.
脑疝最常见于严重脑肿胀，可迅速导致死亡或脑死亡。我们回顾性地确定了影像学指标，以评估目标温度管理（TTM）对脑水肿程度的影响，并确定最能预测大脑半球大面积梗死患者TTM治疗结果的临界值。我们回顾性地分析了21例接受TTM治疗的大脑半球大面积梗死患者的脑部计算机断层扫描（CT）图像。我们排除了4例CT图像质量不佳无法用于评估的患者，最终纳入17例患者。我们将患者分为成功组和失败组。TTM治疗失败定义为死亡或TTM治疗后需要进行去骨瓣减压术（DHC）。梗死面积通过入院时进行的弥散加权成像中的总受限区域来测量。在开始TTM治疗后的第一天和第二天进行CT扫描，随后每两天进行一次。我们在CT扫描上测量透明隔移位（SPS）和松果体移位（PGS）。从症状出现到开始TTM治疗的中位时间为14.5小时。10例患者通过TTM治疗成功，6例患者死亡，1例患者接受了DHC。成功组和失败组的初始梗死面积无显著差异（p = 0.529），但在开始TTM治疗后36 - 72小时的SPS和PGS有差异（平均SPS：5.0对14.9毫米，p = 0.001；平均PGS：2.3对7.9毫米，p = 0.001）。在开始TTM治疗后36 - 72小时，因脑水肿导致TTM治疗失败（SPS≥9.25毫米且PGS≥3.70毫米）的敏感性和阴性预测值均为100%。在开始TTM治疗后36 - 72小时进行的CT扫描上的SPS和PGS可能有助于评估TTM对脑水肿的影响并指导进一步治疗。
