1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
2UMass Chan Medical School, Worcester, Massachusetts.
J Neurosurg. 2023 Aug 11;140(2):537-543. doi: 10.3171/2023.6.JNS222890. Print 2024 Feb 1.
Chronic subdural hematomas (CSDHs) are the among the most common conditions treated by neurosurgeons. Midline shift (MLS) is used as a radiological marker of CSDH severity and the potential need for urgent surgical evacuation. However, a patient's age may affect the degree of MLS for a given hematoma volume. This study aimed to investigate the correlation between the patient's age and the MLS caused by CSDH.
The database of patients treated for CSDH was reviewed in a single institution. Patients with unilateral CSDH were included. To measure CSDH volume, the preprocedural head CT scans underwent 3D volumetric reconstruction using the TeraRecon software. The effect of age on MLS after adjusting for CSDH volume was investigated using linear regression analysis.
Sixty-nine hematomas in 69 patients were included. The age of patients ranged from 25 to 94 years (mean 71.6 years). Hematoma volume and MLS ranged from 27.8 to 215 mL (mean 99.3 mL) and 0-17 mm (mean 6.5 mm), respectively. On multivariate regression analysis, MLS showed a significant independent negative correlation with age after adjusting for CSDH volume (OR -0.11, 95% CI -0.16 to -0.06; p < 0.001), meaning that for a fixed CSDH volume, with each 10-year increase in age the MLS will reduce by 1.1 mm. Moreover, MLS-to-volume ratio showed a significant negative linear correlation with age (r2 = 0.32; p < 0.001). Ten-milliliter increments in CSDH volume resulted in a 1.09-mm increase in MLS in patients younger than 60 years, which is 2.4-fold higher compared to the 0.46-mm increase in those older than 75 years (p < 0.001).
For a fixed CSDH volume, older age correlates with significantly lower MLS. This could be explained by higher parenchymal compliance in older individuals due to increased brain atrophy, and a larger subdural space. Clinical use of MLS to estimate severity of CSDH and gauge treatment decisions should take the patient's age into account.
慢性硬脑膜下血肿（CSDH）是神经外科医生治疗的最常见疾病之一。中线移位（MLS）被用作 CSDH 严重程度和潜在紧急手术清除的放射学标志物。然而，患者的年龄可能会影响给定血肿体积的 MLS 程度。本研究旨在探讨患者年龄与 CSDH 引起的 MLS 之间的相关性。
在一家单机构回顾性分析了接受 CSDH 治疗的患者数据库。纳入单侧 CSDH 患者。为了测量 CSDH 体积，使用 TeraRecon 软件对头 CT 扫描进行了三维容积重建。使用线性回归分析研究了年龄对 CSDH 体积调整后的 MLS 的影响。
69 名患者的 69 个血肿被纳入研究。患者年龄为 25-94 岁（平均 71.6 岁）。血肿体积和 MLS 范围分别为 27.8-215mL（平均 99.3mL）和 0-17mm（平均 6.5mm）。在多变量回归分析中，在调整 CSDH 体积后，MLS 与年龄呈显著负相关（OR-0.11，95%CI-0.16 至-0.06；p<0.001），这意味着对于固定的 CSDH 体积，每增加 10 岁，MLS 将减少 1.1mm。此外，MLS-体积比与年龄呈显著负线性相关（r2=0.32；p<0.001）。在 60 岁以下的患者中，CSDH 体积增加 10mL 会导致 MLS 增加 1.09mm，而在 75 岁以上的患者中，MLS 增加 0.46mm，增加幅度高 2.4 倍（p<0.001）。
对于固定的 CSDH 体积，年龄越大，MLS 越低。这可能是由于脑萎缩导致老年人脑实质顺应性更高，以及更大的硬脑膜下间隙所致。临床使用 MLS 来估计 CSDH 的严重程度和判断治疗决策时，应考虑患者的年龄。
