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Novel CT-based parameters assessing relative cross-sectional area to guide surgical management and predict clinical outcomes in patients with acute subdural hematoma

  • Diagnostic Neuroradiology
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Abstract

Introduction

Acute subdural hematoma (aSDH) is one of the most devastating entities secondary to traumatic brain injury (TBI). Even though radiological computed tomography (CT) findings, such as hematoma thickness (HT), midline shift (MLS), and MLS/HT ratio, have an important prognostic role, they suffer from important drawbacks. We hypothesized that relative cross-sectional area (rCSA) of specific brain regions would provide valuable information about brain compression and swelling, thus being a key determining factor governing the clinical course.

Methods

We performed an 8-year retrospective analysis of patients with moderate to severe TBI with surgically evacuated, isolated, unilateral aSDH. We investigated the influence of aSDH rCSA and ipsilateral hemisphere rCSA along the supratentorial region on the subsequent operative technique employed for aSDH evacuation and patient’s clinical outcomes (early death and Glasgow Outcome Scale [GOS] at discharge and after 1-year follow-up). Different conventional radiological variables were also assessed.

Results

The study included 39 patients. Lower HT, MLS, hematoma volume, and aSDH rCSA showed a significant association with decompressive craniectomy (DC) procedure. Conversely, higher ipsilateral hemisphere rCSA along the dorso-ventral axis and, specifically, ipsilateral hemisphere rCSA at the high convexity level were predictors for DC. CT segmentation analysis exhibited a modest relationship with early death, which was limited to the basal supratentorial subregion, but could not predict long-term outcome.

Conclusion

rCSA is an objectifiable and reliable radiologic parameter available on admission CT that might provide valuable information to optimize surgical treatment.

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Funding

This research was jointly funded by the ISCIII and FEDER European institutions, with FIS project number PI18/01387. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain

    Daniel García-Pérez, Ana M. Castaño-León, Luis Miguel Moreno-Gómez, Olga Esteban-Sinovas, Guillermo García-Posadas, Irene Panero-Pérez, Igor Paredes, Pedro A. Gómez-López & Alfonso Lagares

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  1. Daniel García-Pérez
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  2. Ana M. Castaño-León
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  3. Luis Miguel Moreno-Gómez
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All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript.

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Correspondence to Daniel García-Pérez.

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The study has been conducted in accordance with the ethical standards of the institutional review board (Comité Ético de Investigación Clínica, CEIC, of Hospital Universitario 12 de Octubre).

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Written informed consent was waived by the CEIC because of the retrospective review of data collected in conventional medical records.

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García-Pérez, D., Castaño-León, A.M., Moreno-Gómez, L.M. et al. Novel CT-based parameters assessing relative cross-sectional area to guide surgical management and predict clinical outcomes in patients with acute subdural hematoma. Neuroradiology 65, 489–501 (2023). https://doi.org/10.1007/s00234-022-03087-5

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