gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Effect of intracerebral lesion volume detected in early MRI on SEP and outcome following traumatic brain injury

Einfluss des Volumens im frühen MRT diagnostizierter intrazerebraler Verletzungen auf SEP und Outcome nach Schädel-Hirn-Trauma

Meeting Abstract

  • corresponding author Bernd M. Hölper - Städtisches Klinikum Fulda, Klinik für Neurochirurgie, Fulda
  • B. M. Hoelper - Klinik für Neurochirurgie, Klinikum Fulda, Fulda
  • F. Soldner - Klinik für Neurochirurgie, Klinikum Fulda, Fulda
  • L. Choné - Institut für diagnostische Radiologie, Klinikum Fulda, Fulda
  • R. Behr - Klinik für Neurochirurgie, Klinikum Fulda, Fulda

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.10.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0099.shtml

Veröffentlicht: 23. April 2004

© 2004 Hölper et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

The application of MRI following traumatic brain injury is increasingly used to determine the prognosis of patients. However, it remains unclear if small lesions e.g. in the brainstem have the same impact on outcome compared to large lesions. Furthermore, the influence of the lesion volume on functional measurements such as SEP is unclear. Therefore, we investigated this study to clarify the influence of the lesion volume to both functional measurements as well as to clinical outcome.

Methods

We performed early (<8 days after trauma) MRI studies in 56 severely head injured patients. Each intracerebral lesion was anatomically classified (frontal lobes, corpus callosum, brainstem, basal ganglia, thalamus, internal capsule and limbic system) and its volume was measured. Additionally, median-nerve SEP (M-SEP) and tibial nerve SEP (T-SEP) were acquired in all cases. Outcome (GOS) was recorded one year after trauma.

Results

Volume of lesions in the temporal (9%), parietal (3%), insular (1%) and occipital (4%) lobes did not correlate to GOS. However, there was a significant correlation to GOS for the number (r=-0.36, p=0.096) and the volume (r=-0.47, p<0.05) of frontal lobe lesions. Also the volume of deep structure lesions significantly correlated to GOS (r=-0.65, p<0.005), and the volume in persistent vegetative state (PVS) was significantly higher compared to non-persistent vegetative state (NPVS, p=0.01). Number (r=-0.62, p<0.005) and volume (r=-0.74, p<0.0001) of brainstem lesions correlated significantly to GOS, and PVS differed significantly in number (p=0.012) and in volume (p=0.006) to NPVS. Number and volume of callosal lesions showed no significant relationship to GOS, and only the difference of volume between PVS and NPVS was significant (p<0,02). A significant correlation (p<0.01) was found between the volume of brainstem lesions and M-SEP as well as T-SEP, but this was not found for all other lesions including callosal lesions.

Conclusions

The volume of brainstem lesions correlates highly significant to both clinical outcome and SEP, while this could not be found for any other location. In some patients, very large lobar lesions or callosal lesions might play a role on outcome, but in most of these cases outcome is limited by simultaneous brainstem lesions. Since functional disturbances of SEP are mainly caused by lesions in the brainstem, basal ganglia or parietal cortex, MRI mostly confirms only the suggested localization of the traumatic lesion.