Levin H S, Mendelsohn D, Lilly M A, Yeakley J, Song J, Scheibel R S, Harward H, Fletcher J M, Kufera J A, Davidson K C, Bruce D
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.
Neurosurgery. 1997 Mar;40(3):432-40; discussion 440-1. doi: 10.1097/00006123-199703000-00002.
To characterize late neuropathological findings of pediatric closed head injury (CHI), to assess depth of brain lesion in relation to acute severity, and to assess long-term outcome to test the Ommaya-Gennarelli model.
Magnetic resonance imaging (MRI) at least 3 months postinjury in a prospective sample (n 5 169) and at least 3 years after CHI in a retrospective sample (n 5 82) was studied. Lesion volume was measured by planimetry. Acute CHI severity was measured by the Glasgow Coma Scale. Patients were classified according to the depth of the deepest parenchymal lesion into no lesion, subcortical, and deep central gray/brain stem groups. The outcomes were assessed by the Glasgow Outcome Scale and the Vineland Adaptive Behavior Scale, which were performed at the time of the MRI in the retrospective sample and up to 3 years postinjury in the prospective sample.
Focal brain lesions were present in 55.4% of the total sample. Depth of brain lesion was directly related to severity of acute impairment of consciousness and inversely related to outcome, as measured by both the Glasgow Outcome Scale and the Vineland Adaptive Behavior Scale. A rostrocaudal gradient of hemispheric lesion frequency was observed, whereas the posterior lesions of the corpus callosum were particularly common. Total lesion volume could not explain the depth of lesion effect.
Our findings extend support for the Ommaya-Gennarelli model to pediatric CHI, indicating that depth of brain lesion is related to functional outcome. The relative frequency of focal brain lesions revealed by late MRI is higher than that of previous findings using acute computed tomography. Future investigations could explore whether depth of lesion observed using late MRI is sensitive to neuroprotective interventions.
描述小儿闭合性颅脑损伤（CHI）的晚期神经病理学表现，评估脑损伤深度与急性严重程度的关系，并评估长期预后以验证奥马亚 - 根纳雷利模型。
对前瞻性样本（n = 169）伤后至少3个月及回顾性样本（n = 82）CHI后至少3年进行磁共振成像（MRI）研究。通过平面测量法测量病变体积。急性CHI严重程度采用格拉斯哥昏迷量表进行测量。根据最深实质病变的深度将患者分为无病变、皮质下和深部中央灰质/脑干组。通过格拉斯哥预后量表和文兰适应行为量表评估预后，在回顾性样本的MRI检查时以及前瞻性样本伤后3年内进行评估。
在全部样本中，55.4%存在局灶性脑损伤。脑损伤深度与急性意识障碍严重程度直接相关，与格拉斯哥预后量表和文兰适应行为量表所测量的预后呈负相关。观察到半球病变频率存在前后梯度，而胼胝体后部病变尤为常见。总病变体积无法解释病变深度的影响。
我们的研究结果为奥马亚 - 根纳雷利模型扩展到小儿CHI提供了支持，表明脑损伤深度与功能预后相关。晚期MRI显示的局灶性脑损伤相对频率高于先前使用急性计算机断层扫描的结果。未来的研究可以探索使用晚期MRI观察到的病变深度是否对神经保护干预敏感。
