gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Cerebral perfusion changes in acute subdural haematoma

Cerebrale Perfusionsveränderungen durch akute subdurale Hämatome

Meeting Abstract

  • Jennifer Winkler - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • presenting/speaker Guilherme Santos Piedade - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Christian Rubbert - Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
  • Daniel Hänggi - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Marcel A. Kamp - Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland
  • Philipp Slotty - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV215

doi: 10.3205/22dgnc208, urn:nbn:de:0183-22dgnc2082

Published: May 25, 2022

© 2022 Winkler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Acute subdural hematoma (aSDH) is one of the main reasons for high mortality and morbidity in traumatic brain injury. Prognosis is often poor due to the rapid volume shift and mass effect. Cerebral perfusion is likely affected in this condition. This study quantifies ER perfusion changes in aSDH with perfusion CT (CTP).

Methods: We prospectively collected data of 54 patients with a traumatic aSDH from 2016 to 2020. Glasgow Coma Scale (GCS), perfusion parameters, therapeutic decisions and preoperative imaging data including hematoma width, midlineshift and hematoma localization were analyzed. The cortical perfusion parameters of each hemisphere, the area anterior to the hematoma (AAH), area below the hematoma (ABH), area posterior to the hematoma (PAH) and corresponding mirrored contralateral regions were determined.

Results: We found a significant difference in Tmax in affected and unaffected whole-hemisphere data (mean 4.0s vs. 3.3s, p<0.05, t-test) and a significantly different mean for Tmax in ABH and for the corresponding mirrored area cortical (MAC) (mean 3.8s vs. 3.1s, p<0.05). No significant perfusion changes in cerebral blood flow (CBF), cerebral blood volume (CBV) and MTT (mean CBF 69.6 ml/100g/s vs. 68.8 ml/100g/s, p=0.927; CBV 23.1 ml/100g vs. 22.8 ml/100g, p=0.916; MTT 3.5s vs. 3.5s, p=0.879) were found. In the affected hemisphere, Tmax was significantly higher in patients later treated surgically than in patients managed conservatively (mean Tmax affected hemisphere surgery 4.7s vs. mean Tmax affected hemisphere no surgery 2.7s, p<0.001). In addition, we compared Tmax in the affected hemisphere in patients who survived and patients that died. Although there was no clear relationship between increased Tmax and individual survival, a difference of the mean values in Tmax (mean Tmax affected hemisphere survival 3.5s vs. mean Tmax affected hemisphere clinical death 5.2s, p<0.05) was detected.

Conclusion: There are clear and consistent changes in brain perfusion in aSDH. Especially Tmax was elevated in the underlying cortical area of aSDH. Tmax values may prove to be a sensitive indicator for the need of hematoma evacuation.

Figure 1 [Fig. 1]