Quantitative assessment of brain shifting in the late phase postevacuation in unilateral and bilateral chronic subdural hematomas

Abstract

The postevacuation late phase of brain shifting is statistically greater in bilateral CSDHs than in unilateral CSDHs, which might facilitate bridging vein tearing and consequent rebleeding. This may be one factor accounting for the higher recurrence rate of bilateral CSDHs.

CT-Based Quantitative Analysis for Pathological Features Associated With Postoperative Recurrence and Potential Application Upon Artificial Intelligence: A Narrative Review With a Focus on Chronic Subdural Hematomas

“…The use of this calculation formula was described clearly in the literature. 34 Postevacuation subdural space on the postoperative day 60 (late phase) was statistically greater in bilateral CSDHs than in unilateral CSDH. 34 Through these quantitative methods as mentioned, we can easily deduce the possible postoperative recurrence in CSDHs.…”

“…22 Bilateral CSDHs have been quantitatively proven to have larger residual hematoma volumes, greater BRR, brain shifting, and subdural space than the unilateral one. 33,34 Therefore, we can infer the following: more degree of brain shifting or the shifting in more patent subdural space will incur more risk of damage to the subdural drainage veins and eventually cause an increase in postoperative recurrence in bilateral CSDHs.…”

“…Results showed that bilateral CSDHs were found to exhibit greater extent of brain shifting than their unilateral counterpart between postoperative days 30 and 60 (P < .001), indicating higher risk of postoperative recurrence in bilateral CSDHs. 34…”

“…However, qualitative assessment methods are unable to quantify pathological features of hematomas, as well as temporal and spatial changes in brain shifting postoperatively. We present an overview of CT-based quantitative analysis for pathological features underlying postoperative recurrence of CSDHs in terms of (1) preoperative mean hematoma density (MHD), 32 (2) postoperative brain re-expansion rate (BRR), 33 (3) preoperative and postoperative hematoma volume, 33 (4) temporal and spatial changes in postoperative brain shifting, 34 and (5) postoperative average distance of subdural space (ADSS). 34 The proposed computer-assisted quantitative assessment provides a simple and practical research platform.…”

“…We present an overview of CT-based quantitative analysis for pathological features underlying postoperative recurrence of CSDHs in terms of (1) preoperative mean hematoma density (MHD), 32 (2) postoperative brain re-expansion rate (BRR), 33 (3) preoperative and postoperative hematoma volume, 33 (4) temporal and spatial changes in postoperative brain shifting, 34 and (5) postoperative average distance of subdural space (ADSS). 34 The proposed computer-assisted quantitative assessment provides a simple and practical research platform. We believe that these quantitative methods would aid in clear observation and analysis of the changes in preoperative and postoperative CSDHs, thereby helping physicians to understand the disease progression thoroughly and undertake measures to arrest postoperative recurrence.…”