Preoperative Head CT Assisted Prediction of Acute Encephalocele During Isolated Acute Subdural Hematoma Surgery

Abstract

To investigate more predictors for acute encephalocele in patients during isolated acute subdural hematoma (ASDH) surgery by using clinical data combined with preoperative cranial computed tomography (CT) scan, so as to provide a basis for the development of a more scientific and reasonable treatment strategy. CT images and medical records of 46 patients who underwent neurosurgery for isolated traumatic acute subdural hematoma were collected. The patients with intra-operative acute encephalocele were grouped as the observation group (n=23), and the patients with no intra-operative acute encephalocele, whose age difference was within 5 years were included in the control group (n=23). The t-test and multivariate logistic regression analyses were carried out to evaluate the influence of clinical variables on acute encephalocele. Meanwhile, whether differences among Thickness of hematoma(TH), Midline shift (MLS), Hounsfield units of white matter (HU-WM), Hounsfield units of hematoma (HU-HT) and basal cistern effaced score (CES) measured by cranial CT could be used as predictors of outcomes in patients with acute encephalocele during subdural hematoma surgery was evaluated. There were no significant differences in age, sex, mechanism of injury, the time from trauma to decompression, and the MLS during surgery between the two groups. However, significant differences in preoperative Glasgow Coma Score (GCS), TH, HU-WM and HU-HT between the two groups were observed. The multivariate logistic regression analysis of radiographic data showed that HU-WM and CES were independent risk factors and strong predictors for intra-operative acute encephalocele. The areas under curve of CES and HU-WM were 0.8459 and 0.8336, respectively. The risk factors for acute encephalocele during ASDH operation are identified in this study. An increased risk of intra-operative acute encephalocele is found in patients with lower preoperative GCS, HU-WM, HU-HT and higher preoperative TH and CES, which should help clinicians to develop a more scientific treatment strategy and improve the survival of such kind of patients.