Abstract
Preoperative brain shift after severe brain injury is a prognostic factor for survival. The aim of this study was to determine whether preoperative brain shift in conditions other than severe head injury has significant prognostic value. We analyzed a radiological database of 800 consecutive patients, who underwent neurosurgical treatment. Brain shift was measured at two anatomical landmarks: Monro’s foramina (MF) and the corpus callosum (CC). Four hundred seventy-three patients were included. The disease exerting the highest mean brain shift was acute subdural hematoma (MF 11.6 mm, CC 12.4 mm), followed by intraparenchymal hematoma (MF 10.2 mm, CC 10.3 mm) and malignant ischemia (MF 10.4 mm, CC 10.5 mm). On univariate analysis, brain shift was a significant negative factor for survival in all diseases (p < 0.001). Analyzed individually by group, brain shift at both anatomical landmarks had a statistically significant effect on survival in malignant ischemia and at one anatomical landmark in chronic subdural and intraparenchymal hematomas. Multivariate analysis demonstrated that the only independent factor negatively impacting survival was brain shift at MF (OR = 0.89; 95% CI: 0.84–0.95) and CC (OR = 0.90; 95% CI: 0.85–0.96). Brain shift is a prognostic factor for survival in patients with expansive intracranial lesions in certain neurosurgical diseases. MF and CC are reliable anatomical landmarks and should be quoted routinely in radiological reports as well as in neurosurgical practice.
Highlights
In neurosurgical patients, brain shift on neuroradiological imaging is a key sign in surgical decision-making
This study aimed to evaluate a standard anatomical level at which to measure brain shift and the prognostic value of brain shift in neurosurgical diseases other than a severe head injury that exert a mass effect, in order to compel the routine inclusion of brain shift measurement in radiological reports and neurosurgical practice
Preoperative head computed tomography (CT) scans showed mass effects exerted by intraparenchymal hemorrhage (62 patients), hemorrhage from a ruptured aneurysm (7 patients), malignant ischemia of the middle cerebral artery (14 patients), supratentorial brain tumors, acute subdural hematoma (61 patients), chronic subdural hematoma (182 patients), epidural hematoma (22 patients), and brain abscesses (4 patients) (Table 1)
Summary
Brain shift on neuroradiological imaging is a key sign in surgical decision-making. The first paper dealing with brain shift in intraparenchymal or subdural hematomas or large middle cerebral artery stroke determined that its progressive increase decreases the level of consciousness, up to deep coma [13]. This result has been confirmed, and a larger mean shift is associated with poor outcomes [14]. We daily observe radiological reports lacking brain shift measures or having an overestimated shift missing any anatomic level. This deficiency may either push the neurosurgeon to
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