1
|
Paracino R, De Domenico P, Rienzo ADI, Dobran M. Radiologic and Blood Markers Predicting Long-Term Neurologic Outcome Following Decompressive Craniectomy for Malignant Ischemic Stroke: A Preliminary Single-Center Study. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38657675 DOI: 10.1055/a-2312-9448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Malignant ischemic stroke (MIS) is defined by progressive cerebral edema leading to increased intracranial pressure (ICP), compression of neural structures, and, eventually, death. Decompressive craniectomy (DC) has been advocated as a lifesaving procedure in the management of patients with MIS. This study aims to identify pre- and postoperative predictive variables of neurologic outcomes in patients undergoing DC for MIS. METHODS We conducted a retrospective study of patients undergoing DC in a single center from April 2016 to April 2020. Preoperative workup included baseline clinical status, laboratory data, and brain computed tomography (CT). The primary outcome was the 6-month modified Rankin score (mRS). The secondary outcome was the 30-day mortality. RESULTS During data capture, a total of 58 patients fulfilled the criteria for MIS, of which 22 underwent DC for medically refractory increased ICP and were included in the present analysis. The overall median age was 58.5 years. An immediate (24 hour) postoperative extended Glasgow Outcome Scale (GOSE) score ≥5 was associated with a good 6-month mRS (1-3; p = 0.004). Similarly, low postoperative neutrophils (p = 0.002), low lymphocytes (p = 0.004), decreased neutrophil-to-lymphocyte ratio (NLR; p = 0.02), and decreased platelet-to-lymphocytes ratio (PLR; p = 0.03) were associated with good neurologic outcomes. Preoperative variables independently associated with worsened 6-month mRS were the following: increased age (odds ratio [OR]: 1.10; 95% confidence interval [CI]: 1.01-1.20; p = 0.02), increased National Institutes of Health Stroke Scale (NIHSS) score (OR: 7.8; 95% CI: 2.5-12.5; p = 0.035), Glasgow Coma Scale (GCS) score less than 8 at the time of neurosurgical referral (OR: 21.63; 95% CI: 1.42-328; p = 0.02), and increased partial thromboplastin time (PTT) before surgery (OR: 2.11; 95% CI: 1.11-4; p = 0.02). Decreased postoperative lymphocytes confirmed a protective role against worsened functional outcomes (OR: 0.01; 95% CI: 0.01-0.4; p = 0.02). Decreased postoperative lymphocyte count was associated with a protective role against increased mRS (OR: 0.01; 95% CI: 0.01-0.4; p = 0.02). The occurrence of hydrocephalus at the postoperative CT scan was associated with 30-day mortality (p = 0.005), while the persistence of postoperative compression of the ambient and crural cistern showed a trend towards higher mortality (p = 0.07). CONCLUSIONS This study reports that patients undergoing DC for MIS showing decreased postoperative blood inflammatory markers achieved better 6-month neurologic outcomes than patients with increased inflammatory markers. Similarly, poor NIHSS score, poor GCS score, increased age, and larger PTT values at the time of surgery were independent predictors of poor outcomes. Moreover, the persistence of postoperative compression of basal cisterns and the occurrence of hydrocephalus are associated with 30-day mortality.
Collapse
Affiliation(s)
- Riccardo Paracino
- Department of Neurosurgery, Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | | | - Mauro Dobran
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
2
|
Bruno A, Paletta N, Verma U, Grabowska ME, Haughey HM, Batchala PP, Abay S, Donahue J, Vender J, Sethuraman S, Nichols FT. Predicting Functional Outcome After Decompressive Craniectomy for Malignant Hemispheric Infarction: Clinical and Novel Imaging Factors. World Neurosurg 2021; 158:e1017-e1021. [PMID: 34906752 DOI: 10.1016/j.wneu.2021.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Decompressive craniectomy (DC) is an established optional treatment for malignant hemispheric infarction (MHI). We analyzed relevant clinical factors and computed tomography (CT) measurements in patients with DC for MHI to identify predictors of functional outcome 3-6 months after stroke. METHODS This study was performed at 2 comprehensive stroke centers. The inclusion criteria required DC for MHI, no additional intraoperative procedures (strokectomy or cerebral ventricular drain placement), and documented functional status 3-6 months after the stroke. We classified functional outcome as acceptable if the modified Rankin Scale score was <5, or as unacceptable if it was 5 or 6 (bedbound and totally dependent on others or death). Multiple logistic regression analyzed relevant clinical factors and multiple perioperative CT measurements to identify predictors of acceptable functional outcome. RESULTS Of 87 identified consecutive patients, 66 met the inclusion criteria. Acceptable functional outcome occurred in 35 of 66 (53%) patients. Likelihood of acceptable functional outcome decreased significantly with increasing age (OR 0.92, 95% CI 0.82-0.97, P = 0.004) and with increasing post-DC midline brain shift (OR 0.78, 95% CI 0.64-0.96, P = 0.016), and decreased non-significantly with left-sided stroke (OR 0.30, 95% CI 0.08-1.10, P = 0.069) and with increasing craniectomy barrier thickness (OR 0.92, 95% CI 0.85-1.01, P = 0.076). CONCLUSIONS Patient age and the post-DC midline shift may be useful in prognosticating functional outcome after DC for MHI. Stroke side and craniectomy barrier thickness merit further ideally prospective outcome prediction testing.
Collapse
Affiliation(s)
- Askiel Bruno
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
| | - Nina Paletta
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Uttam Verma
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Monika E Grabowska
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Heather M Haughey
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Prem P Batchala
- Department of Radiology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Solomon Abay
- Department of Radiology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Joseph Donahue
- Department of Radiology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - John Vender
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | | | - Fenwick T Nichols
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| |
Collapse
|
3
|
Yuan R, Wu S, Cheng Y, Ye K, Hao Z, Zhang S, Liu Y, Liu M. Association Between Preoperative Midline Shift Growing Rate and Outcomes of Decompressive Craniectomy in Patients with Malignant Middle Cerebral Artery Infarction. Curr Neurovasc Res 2021; 17:131-139. [PMID: 32031070 DOI: 10.2174/1567202617666200207125552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Whether preoperative midline shift and its growing rate are associated with outcomes of decompressive craniectomy in patients with malignant middle cerebral artery infarction is unknown. METHODS We retrospectively included patients: 1) who underwent decompressive craniectomy for malignant middle cerebral artery infarction in West China Hospital from August 2010 to December 2, 2018) who had at least two brain computed tomography scans before decompressive craniectomy. Midline shift was measured on the first and last preoperative computed tomography scans. Midline shift growing rate was calculated by dividing Δmidline shift value using Δ time. The primary outcome was inadequate decompression of the mass effect. Secondary outcomes were 3 month death and unfavorable outcomes. RESULTS Sixty-one patients (mean age 53.7 years, 57.4% (35/61) male) were included. Median time from onset to decompressive craniectomy was 51.8 h (interquartile range: 39.7-77.8). Rates of inadequate decompression, 3 month death, 3 month modified Rankin Scale 5-6 and 4-6 were 50.8% (31/61), 50.9% (29/57), 64.9% (37/57) and 84.2% (48/57), respectively. The inadequate decompression group had a higher midline shift growing rate than the adequate decompression group (median: 2.7 mm/8 h vs. 1.4 mm/8 h, P=0.041). No intergroup difference of 3 month outcomes was found in terms of preoperative midline shift growing rate. CONCLUSION Higher preoperative midline shift growing rate was associated with inadequate decompression of decompressive craniectomy in patients with malignant middle cerebral artery infarction.
Collapse
Affiliation(s)
- Ruozhen Yuan
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Simiao Wu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yajun Cheng
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaili Ye
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Zilong Hao
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Shihong Zhang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Hong JH, Jeon I, Seo Y, Kim SH, Yu D. Radiographic predictors of clinical outcome in traumatic brain injury after decompressive craniectomy. Acta Neurochir (Wien) 2021; 163:1371-1381. [PMID: 33404876 DOI: 10.1007/s00701-020-04679-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary decompressive craniectomy (DC) is considered for traumatic brain injury (TBI) patients with clinical deterioration, presenting large amounts of high-density lesions on computed tomography (CT). Postoperative CT findings may be suitable for prognostic evaluation. This study evaluated the radiographic predictors of clinical outcome and survival using pre- and postoperative CT scans of such patients. METHODS We enrolled 150 patients with moderate to severe TBI who underwent primary DC. They were divided into two groups based on the 6-month postoperative Glasgow Outcome Scale Extended scores (1-4, unfavorable; 5-8, favorable). Radiographic parameters, including hemorrhage type, location, presence of skull fracture, midline shifting, hemispheric diameter, effacement of cisterns, parenchymal hypodensity, and craniectomy size, were reviewed. Stepwise logistic regression analysis was used to identify the prognostic factors of clinical outcome and 6-month mortality. RESULTS Multivariable logistic regression analysis revealed that age (odds ratio [OR] = 1.09; 95% confidence interval [CI] 1.032-1.151; p = 0.002), postoperative low density (OR = 12.58; 95% CI 1.247-126.829; p = 0.032), and postoperative effacement of the ambient cistern (OR = 14.52; 95% CI 2.234-94.351; p = 0.005) and the crural cistern (OR = 4.90; 95% CI 1.359-17.678; p = 0.015) were associated with unfavorable outcomes. Postoperative effacement of the crural cistern was the strongest predictor of 6-month mortality (OR = 8.93; 95% CI 2.747-29.054; p = 0.000). CONCLUSIONS Hemispheric hypodensity and effacement of the crural and ambient cisterns on postoperative CT after primary DC seems to associate with poor outcome in patients with TBI.
Collapse
Affiliation(s)
- Jung Ho Hong
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea
| | - Ikchan Jeon
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea
| | - Youngbeom Seo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea
| | - Seong Ho Kim
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea
| | - Dongwoo Yu
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea.
| |
Collapse
|
5
|
Wang H, Baker EW, Mandal A, Pidaparti RM, West FD, Kinder HA. Identification of predictive MRI and functional biomarkers in a pediatric piglet traumatic brain injury model. Neural Regen Res 2021; 16:338-344. [PMID: 32859794 PMCID: PMC7896230 DOI: 10.4103/1673-5374.290915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Traumatic brain injury (TBI) at a young age can lead to the development of long-term functional impairments. Severity of injury is well demonstrated to have a strong influence on the extent of functional impairments; however, identification of specific magnetic resonance imaging (MRI) biomarkers that are most reflective of injury severity and functional prognosis remain elusive. Therefore, the objective of this study was to utilize advanced statistical approaches to identify clinically relevant MRI biomarkers and predict functional outcomes using MRI metrics in a translational large animal piglet TBI model. TBI was induced via controlled cortical impact and multiparametric MRI was performed at 24 hours and 12 weeks post-TBI using T1-weighted, T2-weighted, T2-weighted fluid attenuated inversion recovery, diffusion-weighted imaging, and diffusion tensor imaging. Changes in spatiotemporal gait parameters were also assessed using an automated gait mat at 24 hours and 12 weeks post-TBI. Principal component analysis was performed to determine the MRI metrics and spatiotemporal gait parameters that explain the largest sources of variation within the datasets. We found that linear combinations of lesion size and midline shift acquired using T2-weighted imaging explained most of the variability of the data at both 24 hours and 12 weeks post-TBI. In addition, linear combinations of velocity, cadence, and stride length were found to explain most of the gait data variability at 24 hours and 12 weeks post-TBI. Linear regression analysis was performed to determine if MRI metrics are predictive of changes in gait. We found that both lesion size and midline shift are significantly correlated with decreases in stride and step length. These results from this study provide an important first step at identifying relevant MRI and functional biomarkers that are predictive of functional outcomes in a clinically relevant piglet TBI model. This study was approved by the University of Georgia Institutional Animal Care and Use Committee (AUP: A2015 11-001) on December 22, 2015.
Collapse
Affiliation(s)
- Hongzhi Wang
- Department of Statistics, University of Georgia, Athens, GA, USA
| | - Emily W Baker
- Regenerative Bioscience Center; Department of Animal and Dairy Science, University of Georgia, Athens, GA, USA
| | - Abhyuday Mandal
- Department of Statistics, University of Georgia, Athens, GA, USA
| | | | - Franklin D West
- Regenerative Bioscience Center; Department of Animal and Dairy Science, University of Georgia, Athens, GA, USA
| | - Holly A Kinder
- Regenerative Bioscience Center; Department of Animal and Dairy Science, University of Georgia, Athens, GA, USA
| |
Collapse
|
6
|
Lan Z, Richard SA, Li Q, Wu C, Zhang Q, Chen R, Yang C. Outcomes of patients undergoing craniotomy and decompressive craniectomy for severe traumatic brain injury with brain herniation: A retrospective study. Medicine (Baltimore) 2020; 99:e22742. [PMID: 33120775 PMCID: PMC7581028 DOI: 10.1097/md.0000000000022742] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The treatment of severe traumatic brain injury (TBI) with brain herniation is challenging because outcomes are often associated with high mortality and morbidity. Our aim was to identity factors contributing to decompressive craniectomy (DC) and evaluate treatment outcomes in patients with severe TBI with brain herniation.In this retrospective study, we analyzed medical records of severe TBI with brain herniation from May 2009 to December 2013. We reviewed their demographic data, mechanism of injury, Glasgow Coma Scale (GCS) score, pupil status, computed tomography findings, surgical treatment methods, time interval between brain herniation and surgery, as well as outcomes. GCS and pupil status are clinical parameters for detecting increase intracranial pressure while brain parenchyma bulged above the inner plate of the skull during operation indicated brain swelling as well as increased intracranial pressure on which basis the decision to perform DC or craniotomy was determined intraoperatively.One hundred ninety-four patients were included in the study. We performed DC in 143 of the patients while 51 of them we performed craniotomy. There were no statistically significant differences in the age, gender, or injury mechanism between the 2 groups. GCS, pupillary dilation, midline shift, hematoma type and timing of surgery were associated with DC. Nevertheless, logistic regression analysis revealed that hematoma type and timing of surgery were significantly associated with favorable DC outcomes (P < .001 and P = .023). Subdural hematoma and timing of surgery >1 hour were both identified as risk factors for DC. Six months after TBI, 34.0% of patients exhibited favorable outcomes. Overall mortality rate was 30.4%. Age, GCS, pupil dilation, hematoma type, and timing of surgery were all associated with patient outcomes. Further logistic regression analysis revealed that, lower GCS, bilateral pupil dilation, timing of surgery >1 hour, and advanced age were independent risk factors for poor outcomes (P = .001, P = .037, P = .028, and P = .001, respectively).Our study revealed that, DC is not mandatory for all TBI patients with brain herniation. Nevertheless, DC decreases mortality rate in severe TBI patients with brain herniation. Subdural hematoma and timing of surgery >1 hour are key indicators for DC. Lower GCS, bilateral pupil dilation, delayed timing of surgery and advance age are indicators of poor outcomes.
Collapse
Affiliation(s)
- Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
- Department of Medicine, Princefield University, Ghana West Africa
| | - Qiang Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Cong Wu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Qiao Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Ruiqi Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chaohua Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| |
Collapse
|
7
|
Rauen K, Reichelt L, Probst P, Schäpers B, Müller F, Jahn K, Plesnila N. Decompressive Craniectomy Is Associated With Good Quality of Life Up to 10 Years After Rehabilitation From Traumatic Brain Injury. Crit Care Med 2020; 48:1157-1164. [PMID: 32697486 DOI: 10.1097/ccm.0000000000004387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Traumatic brain injury is the number one cause of death in children and young adults and has become increasingly prevalent in the elderly. Decompressive craniectomy prevents intracranial hypertension but does not clearly improve physical outcome 6 months after traumatic brain injury. However, it has not been analyzed if decompressive craniectomy affects traumatic brain injury patients' quality of life in the long term. DESIGN Therefore, we conducted a cross-sectional study assessing health-related quality of life in traumatic brain injury patients with or without decompressive craniectomy up to 10 years after injury. SETTING Former critical care patients. PATIENTS Chronic traumatic brain injury patients having not (n = 37) or having received (n = 98) decompressive craniectomy during the acute treatment. MEASUREMENTS AND MAIN RESULTS Decompressive craniectomy was necessary in all initial traumatic brain injury severity groups. Eight percent more decompressive craniectomy patients reported good health-related quality of life with a Quality of Life after Brain Injury total score greater than or equal to 60 compared with the no decompressive craniectomy patients up to 10 years after traumatic brain injury (p = 0.004). Initially, mild classified traumatic brain injury patients had a median Quality of Life after Brain Injury total score of 83 (decompressive craniectomy) versus 62 (no decompressive craniectomy) (p = 0.028). Health-related quality of life regarding physical status was better in decompressive craniectomy patients (p = 0.025). Decompressive craniectomy showed a trend toward better health-related quality of life in the 61-85-year-old reflected by median Quality of Life after Brain Injury total scores of 62 (no decompressive craniectomy) versus 79 (decompressive craniectomy) (p = 0.06). CONCLUSIONS Our results suggest that decompressive craniectomy is associated with good health-related quality of life up to 10 years after traumatic brain injury. Thus, decompressive craniectomy may have an underestimated therapeutic potential after traumatic brain injury.
Collapse
Affiliation(s)
- Katrin Rauen
- Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Institute for Stroke and Dementia Research (ISD), University of Munich Medical Center, Munich, Germany
- Department of Geriatric Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Institute for Regenerative Medicine (IREM), University of Zurich, Schlieren, Switzerland
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), University of Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, University of Munich Medical Center, Munich, Germany
- Munich Cluster for Systems Neurology (Synergy), Munich, Germany
| | - Lara Reichelt
- Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Institute for Stroke and Dementia Research (ISD), University of Munich Medical Center, Munich, Germany
| | - Philipp Probst
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), University of Munich, Munich, Germany
| | | | | | - Klaus Jahn
- Schoen Clinic Bad Aibling, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders, University of Munich Medical Center, Munich, Germany
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research (ISD), University of Munich Medical Center, Munich, Germany
- Munich Cluster for Systems Neurology (Synergy), Munich, Germany
| |
Collapse
|
8
|
Kinder HA, Baker EW, Wang S, Fleischer CC, Howerth EW, Duberstein KJ, Mao H, Platt SR, West FD. Traumatic Brain Injury Results in Dynamic Brain Structure Changes Leading to Acute and Chronic Motor Function Deficits in a Pediatric Piglet Model. J Neurotrauma 2019; 36:2930-2942. [PMID: 31084386 DOI: 10.1089/neu.2018.6303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in children. Pediatric TBI patients often suffer from crippling cognitive, emotional, and motor function deficits that have negative lifelong effects. The objective of this study was to longitudinally assess TBI pathophysiology using multi-parametric magnetic resonance imaging (MRI), gait analysis, and histological approaches in a pediatric piglet model. TBI was produced by controlled cortical impact in Landrace piglets. MRI data, including from proton magnetic resonance spectroscopy (MRS), were collected 24 hours and 12 weeks post-TBI, and gait analysis was performed at multiple time-points over 12 weeks post-TBI. A subset of animals was sacrificed 24 hours, 1 week, 4 weeks, and 12 weeks post-TBI for histological analysis. MRI results demonstrated that TBI led to a significant brain lesion and midline shift as well as microscopic tissue damage with altered brain diffusivity, decreased white matter integrity, and reduced cerebral blood flow. MRS showed a range of neurochemical changes after TBI. Histological analysis revealed neuronal loss, astrogliosis/astrocytosis, and microglia activation. Further, gait analysis showed transient impairments in cadence, cycle time, % stance, step length, and stride length, as well as long-term impairments in weight distribution after TBI. Taken together, this study illustrates the distinct time course of TBI pathoanatomic and functional responses up to 12 weeks post-TBI in a piglet TBI model. The study of TBI injury and recovery mechanisms, as well as the testing of therapeutics in this translational model, are likely to be more predictive of human responses and clinical outcomes compared to traditional small animal models.
Collapse
Affiliation(s)
- Holly A Kinder
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Animal and Dairy Science, University of Georgia, Athens, Georgia
| | - Emily W Baker
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Animal and Dairy Science, University of Georgia, Athens, Georgia
| | - Silun Wang
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Candace C Fleischer
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Elizabeth W Howerth
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Pathology, University of Georgia, Athens, Georgia
| | - Kylee J Duberstein
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Animal and Dairy Science, University of Georgia, Athens, Georgia
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Simon R Platt
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia
| | - Franklin D West
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia.,Department of Animal and Dairy Science, University of Georgia, Athens, Georgia
| |
Collapse
|
9
|
Jeong WJ, Bang JS, Yum KS, Lee S, Chung I, Kwon OK, Oh CW, Kim BJ, Bae HJ, Han MK. Radiologic Measurement of Brain Swelling in Patients with Large Hemispheric Infarctions During Targeted Temperature Management. Ther Hypothermia Temp Manag 2018; 8:136-142. [PMID: 29447082 DOI: 10.1089/ther.2017.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Brain herniation is most often the result of severe brain swelling and can rapidly lead to death or brain death. We retrospectively identified radiologic indicators to evaluate the effects of targeted temperature management (TTM) on the extent of cerebral edema and determine the cutoff values that best predict TTM outcomes in patients with large hemispheric infarction. We retrospectively reviewed brain computed tomography (CT) scans of 21 patients with large hemispheric infarctions, who were treated with TTM. We excluded 4 patients whose CT scans were inadequate for evaluation, which left 17 patients. We divided the patients into success and failure groups. TTM failure was defined as death or the need for decompressive hemicraniectomy (DHC) after TTM. Infarction size was measured as the total restricted area in diffusion-weighted imaging that was performed on admission. CT scans were obtained on the first and second days after TTM initiation and then every 2 days. We measured septum pellucidum shifts (SPS) and pineal gland shifts (PGS) on CT scans. The median time from symptom onset to TTM initiation was 14.5 hours. Ten patients were successfully treated with TTM, six patients died, and one patient underwent a DHC. Initial infarction sizes were not significantly different between the success and failure groups (p = 0.529), but the SPS and PGS at 36-72 hours after TTM initiation were (mean SPS: 5.0 vs. 14.9 mm, p = 0.001; mean PGS: 2.3 vs. 7.9 mm, p = 0.001). The sensitivity and negative predictive value for TTM failure caused by cerebral edema (SPS ≥9.25 mm and PGS ≥3.70 mm) at 36-72 hours after TTM initiation were both 100%. The SPS and PGS on CT scans taken 36-72 hours after TTM initiation may help to estimate the effect of TTM on cerebral edema and guide further treatment.
Collapse
Affiliation(s)
- Won Joo Jeong
- 1 Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Jae Seung Bang
- 1 Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Kyu Sun Yum
- 2 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Sangkil Lee
- 3 Department of Neurology, Chungbuck National University Hospital , Cheongju, South Korea
| | - Inyoung Chung
- 2 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - O-Ki Kwon
- 1 Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Chang Wan Oh
- 1 Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Beom Joon Kim
- 2 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Hee-Joon Bae
- 2 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Moon-Ku Han
- 2 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| |
Collapse
|
10
|
Radiographic Findings of Distressed Venous Stents and Inferior Vena Cava Filters: Clinical Implications. AJR Am J Roentgenol 2017; 209:1150-1157. [DOI: 10.2214/ajr.16.17750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
11
|
Albert AF, Kirkman MA. Clinical and Radiological Predictors of Malignant Middle Cerebral Artery Infarction Development and Outcomes. J Stroke Cerebrovasc Dis 2017; 26:2671-2679. [PMID: 28736129 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Optic nerve sheath diameter (ONSD) can predict intracranial hypertension and outcomes in severe traumatic brain injury. Its utility in middle cerebral artery (MCA) stroke is unknown. AIMS We reviewed serial radiological measurements, including ONSD, in patients with MCA stroke undergoing decompressive craniectomy (DC) for malignant MCA syndrome and compared demographic, clinical, and radiological data with an age- and gender-matched group of nonmalignant MCA stroke patients. METHODS Patients admitted to a large tertiary hospital in London, UK, between April 2012 and October 2016 with MCA infarction were identified through 2 data sources. We quantified ONSD, eyeball transverse diameter (ETD), ONSD/ETD ratio, midline shift (MLS), and infarct volume on computed tomography (CT). RESULTS We identified 19 patients (mean age = 49.8 years [standard deviation = 12.5]) with malignant MCA stroke and 19 patients (47.8 years [16.0]) with nonmalignant MCA stroke. Mean ONSD, ONSD/ETD ratio, MLS, and infarct volume on initial CT all significantly increased after developing malignant MCA syndrome and decreased (except infarct volume, which increased) following DC (all Ps <.05). ONSD and ONSD/ETD ratios in the malignant group did not correlate with functional outcomes but were significantly higher on initial CT compared with the nonmalignant group (mean ONSD: 5.66 mm [.6] versus 4.97 mm [.5], P = .001; mean ONSD/ETD ratio: .25 [.03] versus .22 [.02], P = .002). CONCLUSIONS ONSD, ONSD/ETD ratio, MLS, and infarct volume change dynamically in patients with malignant MCA infarction who undergo DC. An ONSD of more than 5.25 mm and an ONSD/ETD ratio of more than .232 on initial CT may identify MCA stroke patients at high risk of developing malignant MCA syndrome.
Collapse
Affiliation(s)
| | - Matthew A Kirkman
- Department of Neurosurgery, The Royal London Hospital, Barts Heath NHS Trust, London, UK; The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London, UK.
| |
Collapse
|