Background: This study primarily aimed to assess the volumetric attributes of the midbrain and perimesencephalic structures preoperatively and following surgical interventions in patients diagnosed with brain herniation secondary to traumatic brain injury (TBI).

Methods: We evaluated patients based on radiological findings and clinical symptoms indicative of brain herniation. We performed semi-automated segmentation of the intracranial structures most relevant to trauma and of interest for the current study, such as hematoma, ventricles, midbrain, and perimesencephalic cisterns. Using preoperative and postoperative computed tomography scans, we measured and analyzed the volume of these structures. Patients were grouped based on their discharge Glasgow Coma Scale (GCS) scores: GCS 15 and non-GCS 15.

Results: From May 2018 to February 2020, we included 20 patients in the study. Our volumetric analysis revealed that preoperative midbrain volume (5.84 cc vs. 4.37 cc, P = 0.034) was a significant differentiator between GCS 15 and non-GCS 15 groups. Preoperative midbrain volume remained significant in univariate (odds ratio [OR] = 2.280, 95% confidence interval (CI) = 1.126-5.929, P = 0.04) and multivariate logistic regression analysis (adjusted OR = 3.204, 95% CI = 1.228-12.438, P = 0.038) even after adjusting for age, sex, and admission GCS score. We identified a cut-off point of 4.86 ccs in preoperative midbrain volume, which demonstrated a discriminatory performance of 0.788 area under the receiver operating characteristic curve, 80.0% accuracy, 77.8% sensitivity, and 81.8% specificity between the two groups.

Conclusion: Our findings suggest that patients presenting with lesser midbrain compression preoperatively tended to have improved clinical outcomes postsurgery. Thus, we propose that this preoperative midbrain volume cut-off point holds predictive value for clinical outcomes within our cohort.

Keywords: Brain herniation; Hematoma; Midbrain; Traumatic brain injury; Volumetric analysis.

Copyright: © 2024 Surgical Neurology International.

背景： 本研究主要旨在评估脑外伤（TBI）继发性脑疝患者在手术前后中脑及周边结构的体积属性。

方法： 我们根据影像学发现和临床症状对疑似脑疝的患者进行了评估。我们对创伤最相关的颅内结构，如血肿、脑室、中脑以及桥池等进行了半自动分割。通过术前和术后CT扫描，测量并分析了这些结构的体积。根据出院时格拉斯哥昏迷量表（GCS）评分将患者分为两组：GCS 15分及非GCS 15分。

结果： 从2018年5月至2020年2月，我们纳入了20名研究对象。体积分析显示术前中脑体积（5.84立方厘米 vs 4.37立方厘米, P = 0.034）是GCS 15分和非GCS 15分组之间的一个显著差异因素。在单变量（比值比[OR] = 2.280，95%置信区间(CI) = 1.126-5.929, P = 0.04）和多变量逻辑回归分析中（调整后 OR = 3.204，95% CI = 1.228-12.438, P = 0.038），术前中脑体积在调整年龄、性别及入院GCS评分后仍具有显著性。我们确定了术前中脑体积的临界值为4.86立方厘米，该值展示了受试者操作特征曲线下的面积（AUC）为0.788，准确率为80.0%，灵敏度为77.8%，特异度为81.8%。

结论： 我们的研究结果表明，在手术前中脑压缩程度较轻的患者在术后往往有更好的临床预后。因此，我们提出这一术前中脑体积临界值对本队列患者的临床预后具有预测价值。

关键词： 脑疝；血肿；中脑；创伤性脑损伤；体积分析。

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