The surgical outcome of traumatic extra-axial hematomas causing brain herniation in children

Association Between Gray-White Matter Ratio in Computed Tomography and Outcome in Patients with Extra-Axial Hematoma

OBJECTIVE

To evaluate relationship between gray-white matter ratio (GWR) on computed tomography and prognosis in patients with extra-axial hematoma.

METHODS

Patients with extra-axial hematoma who had undergone surgical treatment at Qinghai Provincial People's Hospital from September 2016 to December 2017 were included. GWR values were calculated by measuring values of gray matter and white matter in Hounsfield units in noninjury sites of basal ganglia. According to Glasgow Outcome Scale score at 3 months after operation, patients were divided into good prognosis (Glasgow Outcome Scale score 4-5) and poor prognosis (Glasgow Outcome Scale score 1-3) groups.

RESULTS

Of 103 patients who met inclusion criteria and were analyzed, 24 had with a poor outcome, including 5 deaths, and 79 patients had a good outcome. There were significant differences between the 2 groups in terms of age, type of hematoma, admission Glasgow Coma Scale score, and presence of hernia (all P < 0.05). Postoperative HU values of posterior capsule, postoperative GWR values, and difference between preoperative and postoperative GWR values had statistical significance (all P < 0.05). Receiver operating characteristic curve showed that difference between preoperative and postoperative GWR values was the best predictor of poor outcome.

CONCLUSIONS

The difference between preoperative or postoperative GWR values has a higher sensitivity and greater area under the curve to predict patient outcome. Measuring the difference between preoperative and postoperative GWR values may be useful as an objective early predictor of outcome in patients with extra-axial hematoma. Larger samples and multicenter prospective studies are still required.

Decompressive craniectomy for traumatic intracranial hypertension: application in children

Traumatic brain injury remains prevalent in children, particularly within the adolescent age group. In severe injury, the priority of treatment is to stabilise the patient initially and prevent the evolution of brain swelling and secondary ischaemia using tiers of medical therapy. The final stage of intervention for such patients is a decompressive craniectomy. Here in, we identify the current evidence for performing decompressive crainectomy in children including the results from the RESCUEicp study.