Korhonen Tommi K, Arponen Otso, Steinruecke Moritz, Pecorella Ilaria, Mee Harry, Yordanov Stefan, Viaroli Edoardo, Guilfoyle Mathew R, Kolias Angelos, Timofeev Ivan, Hutchinson Peter, Helmy Adel
Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust & University of Cambridge, Cambridge, UK.
Department of Neurosurgery, Neurocenter OYS, Oulu University Hospital, Oulu, Finland.
J Cachexia Sarcopenia Muscle. 2024 Aug;15(4):1441-1450. doi: 10.1002/jcsm.13489. Epub 2024 May 8.
Chronic subdural haematoma (CSDH) drainage is a common neurosurgical procedure. CSDHs cause excess mortality, which is exacerbated by frailty. Sarcopenia contributes to frailty - its key component, low muscle mass, can be assessed using cross-sectional imaging. We aimed to examine the prognostic role of temporal muscle thickness (TMT) measured from preoperative computed tomography head scans among patients undergoing surgical CSDH drainage.
We retrospectively identified all patients who underwent CSDH drainage within 1 year of February 2019. We measured their mean TMT from preoperative computed tomography scans, tested the reliability of these measurements, and evaluated their prognostic value for postoperative survival.
One hundred and eighty-eight (122, 65% males) patients (median age 78 years, IQR 70-85 years) were included. Thirty-four (18%) patients died within 2 years, and 51 (27%) died at a median follow-up of 39 months (IQR 34-42 months). Intra- and inter-observer reliability of TMT measurements was good-to-excellent (ICC 0.85-0.97, P < 0.05). TMT decreased with age (Pearson's r = -0.38, P < 0.001). Females had lower TMT than males (P < 0.001). The optimal TMT cut-off values for predicting two-year survival were 4.475 mm for males and 3.125 mm for females. TMT below these cut-offs was associated with shorter survival in both univariate (HR 3.24, 95% CI 1.85-5.67) and multivariate (HR 1.86, 95% CI 1.02-3.36) analyses adjusted for age, ASA grade and bleed size. The effect of TMT on mortality was not mediated by age.
In patients with CSDH, TMT measurements from preoperative imaging were reliable and contained prognostic information supplemental to previously known predictors of poor outcomes.
慢性硬膜下血肿（CSDH）引流是一种常见的神经外科手术。CSDH会导致额外的死亡率，而身体虚弱会加剧这种情况。肌肉减少症会导致身体虚弱，其关键组成部分——低肌肉量，可以通过横断面成像进行评估。我们旨在研究术前头颅计算机断层扫描测量的颞肌厚度（TMT）在接受CSDH手术引流患者中的预后作用。
我们回顾性确定了2019年2月1年内所有接受CSDH引流的患者。我们从术前计算机断层扫描中测量他们的平均TMT，测试这些测量的可靠性，并评估其对术后生存的预后价值。
纳入了188例患者（122例，65%为男性）（中位年龄78岁，IQR 70 - 85岁）。34例（18%）患者在2年内死亡，51例（27%）在中位随访39个月（IQR 34 - 42个月）时死亡。TMT测量的观察者内和观察者间可靠性良好至优秀（ICC 0.85 - 0.97，P < 0.05）。TMT随年龄下降（Pearson相关系数r = -0.38，P < 0.001）。女性的TMT低于男性（P < 0.001）。预测两年生存的最佳TMT临界值男性为4.475毫米，女性为3.125毫米。在根据年龄、美国麻醉医师协会（ASA）分级和出血量进行调整的单因素（HR 3.24，95% CI 1.85 - 5.67）和多因素（HR 1.86，95% CI 1.02 - 3.36）分析中，低于这些临界值的TMT与较短的生存期相关。TMT对死亡率的影响不受年龄介导。
在CSDH患者中，术前成像测量的TMT是可靠的，并且包含了补充先前已知不良预后预测因素的预后信息。
