Delmotte Pierre-Romain, Perret Liaudet Bérenger, Torkomian Gregory, Unrung Jean, Cassereau Didier, Debarle Clara, Mathon Bertrand, Perlbarg Vincent, Puybasset Louis, Degos Vincent, Jacquens Alice
AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, Paris , France.
Sorbonne University, Paris , France.
Neurosurgery. 2024 Nov 18;97(1):130-137. doi: 10.1227/neu.0000000000003274.
Post-traumatic brain injury (TBI) lesions, which combine brain atrophy and white matter injuries, can lead to progressive post-traumatic encephalopathy. However, the specific involvement of the cerebellum, which participates in cognitive, executive, and sensory functions, has been little studied. The aim of this work was to explore the long-term cerebellar consequences of severe TBI.
In this retrospective study, patients included were hospitalized for a severe TBI and reassessed after discharge with a clinical examination and a MRI with diffusion tensor imaging. Patients were compared with a population of healthy volunteers. For a subgroup of this cohort, we analyzed the evolution of late post-TBI lesions on MRI up to 10 years after TBI.
Ninety-seven patients reassessed 5 [3; 6] years after the TBI were included. Volume loss was revealed in the whole cerebellum ( P = .01) and especially in the anterior lobe ( P < .005) with a decrease in grey matter volume ( P = 6.10 -3 ). The mean diffusivity was increased in 4 cerebellar areas which are the right lower, right upper, left lower, and left upper cerebellar peduncles while the fractional anisotropy was decreased in all studied areas ( P < 10 -3 ). The longitudinal analysis (n = 17 patients) showed no progression of MRI lesions beyond the acute phase.
This work shows that even if direct cerebellar damage is rare, long-term post-TBI cerebellar lesions can be observed. Therefore, clinical correlates of cerebellar lesions should be considered more systematically.
创伤性脑损伤（TBI）病变合并脑萎缩和白质损伤，可导致进行性创伤后脑病。然而，参与认知、执行和感觉功能的小脑的具体受累情况研究较少。本研究旨在探讨重度TBI对小脑的长期影响。
在这项回顾性研究中，纳入因重度TBI住院并在出院后通过临床检查和磁共振成像（MRI）及弥散张量成像进行重新评估的患者。将患者与健康志愿者群体进行比较。对于该队列的一个亚组，我们分析了TBI后长达10年的MRI上晚期TBI病变的演变情况。
纳入了97例在TBI后5[3；6]年进行重新评估的患者。整个小脑出现体积减小（P = 0.01），尤其是前叶（P < 0.005），灰质体积减少（P = 6.10 -3）。4个小脑区域（右下、右上、左下和左上小脑脚）的平均扩散率增加，而所有研究区域的分数各向异性降低（P < 10 -3）。纵向分析（n = 17例患者）显示MRI病变在急性期后无进展。
本研究表明，即使直接的小脑损伤很少见，但仍可观察到TBI后小脑的长期病变。因此，应更系统地考虑小脑病变的临床相关性。
