Abstract
Cadaveric studies on humans have shown anatomical variabilities in the morphometric characteristics of the tentorial notch. These anatomical variations could influence the worsening of neurocritical patients. 1) To investigate the morphometric characteristics of the tentorial notch in neurocritical patients using computed tomography (CT); 2) To investigate the correlation between tentorial notch measurements by CT and by magnetic resonance imaging (MRI); and 3) To analyze the individual variability of the tentorial notch anatomy seen in neurocritical patients. Prospective series of neurocritical patients was examined. An imaging protocol for measurements was designed for CT and MRI. The level of the agreement of the measurements from CT and MR images was established. According to the measurements found, patients were divided into different types of tentorial notch. We studied 34 neurocritical patients by CT and MRI. Measurements of the tentorial notch via CT and MRI showed significant agreement: concordance correlation coefficient of 0.96 for notch length and 0.85 for maximum width of tentorial notch. Classification of tentorial notch measurements according to the criteria established by Adler and Milhorat, we found the following: 15 patients (58%) corresponded to a "short" subtype; 7 (21%) to "small"; 3 (9%) to "narrow"; 2 (6%) to "wide"; 2 (6%) to "large"; 1 (3%) to "long"; and 4 (12%) to "typical". The anatomical variability of the tentorial notch could be detected in vivo by means of CT scan and MRI. Good agreement between the measurements made using these two imaging methods was found.
Highlights
Pathological processes that increase intracranial volume may generate ischemic lesions through compression and distortion of the brain and its vessels
A prospective study was conducted on non-consecutive patients admitted to the intensive care units (ICUs) of Clinicas and Maciel hospitals with acute and severe neurological disease and initial Glasgow Coma Scale scores (GCSs) of 8 or less (including head trauma, subarachnoid hemorrhage (SAH), intracerebral hemorrhage and cerebral infarction), between January 2015 and December 2017
NL measurements were made in the mid-sagittal plane and MNW measurements in the axial plane, in coronal view, with extrapolation of the reference points described in the MRI algorithm
Summary
Pathological processes that increase intracranial volume may generate ischemic lesions through compression and distortion of the brain and its vessels. The introduction of CT and, especially, MRI has promoted a review of the classic concepts of brain displacement, with emphasis on the early biophysical phenomena of brainstem distortion[6,7,8,9] In this way, it can be established that there are basically three clinical determinants of such displacements: a) the volume of the mass lesions; b) their topography; and c) the rapidity of their growth. Cadaveric studies on humans have shown anatomical variabilities in the morphometric characteristics of the tentorial notch. These anatomical variations could influence the worsening of neurocritical patients. Good agreement between the measurements made using these two imaging methods was found
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