Abstract
Hydrocephalus is a common complication following subarachnoid haemorrhage (SAH) arising from spontaneous aneurysm rupture. The Hounsfield unit (HU) value from computed tomography scans may reflect bone mineral density, which correlates with body mass index, which in turn is related to post-SAH ventricle size changes. We herein investigated potential associations between frontal skull HU values and ventricle size changes after SAH. HU values from four different areas in the frontal bone were averaged to minimize measurement errors. The bicaudate index and Evans ratio were measured using both baseline and follow-up CT images. CT images with bicaudate index >0.2 and Evans ratio >0.3 simultaneously were defined as indicating ventriculomegaly. We included 232 consecutive patients with SAH due to primary spontaneous aneurysm rupture, who underwent clipping over almost a 9-year period at a single institution. The first tertile of frontal skull HU values in older patients (≥55 years) was an independent predictor of ventriculomegaly after SAH, as compared to the third tertile in younger patients (hazard ratio, 4.01; 95% confidence interval 1.21–13.30; p = 0.023). The lower frontal skull HU value independently predicted ventricular enlargement post-SAH, due to the potential weak integrity of subarachnoid trabecular structures in younger patients.
Highlights
Hydrocephalus is a common complication of subarachnoid haemorrhage (SAH) due to spontaneous aneurysmal rupture
In a recent evaluation of whether bone mineral density (BMD) is directly associated with ventricular enlargement after SAH, we showed that higher Body mass index (BMI) may be an independent factor in the suppression of ventricle growth after SAH due to aneurysm rupture[2]
Previous studies have indicated that Hounsfield unit (HU) values obtained from computed tomography (CT) scans may be an alternative method for determining regional BMD3–6
Summary
Hydrocephalus is a common complication of subarachnoid haemorrhage (SAH) due to spontaneous aneurysmal rupture. Body mass index (BMI) is thought to correlate with bone mineral density (BMD). In a recent evaluation of whether BMD is directly associated with ventricular enlargement after SAH, we showed that higher BMI may be an independent factor in the suppression of ventricle growth after SAH due to aneurysm rupture[2]. In the present study, we measured HU values in the frontal skull to evaluate the potential association with ventricular enlargement during the clinical course of SAH. The Evans ratio and the bicaudate index (BCI), which are widely used in the neurosurgical field, were used to define ventricular enlargement in consecutive patients with aneurysmal SAH, who underwent clipping at a single institution
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