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BACKGROUND AND PURPOSE:A standardized and validated method to measure brain shifts in malignant middle cerebral artery (MCA) stroke with decompressive hemicraniectomy (DHC) could facilitate clinical decision making, prognostication, and comparison of results between studies. METHODS:We tested for reliability simplified methods to measure transcalvarial herniation, midline brain shift, and the contralateral cerebral ventricular atrium in malignant MCA stroke after DHC. Multiple raters measured brain shifts on post-DHC computed tomography (CT) scans with aligned and unaligned slice orientations in 25 patients. We compared the simplified measurements to previously reported more meticulous measurements. RESULTS: The simplified measurements correlate well with the more meticulous measurements on both aligned and unaligned CTs (intraclass correlation coefficients .72-.89). CONCLUSIONS: These simplified and expedient methods of measuring brain shifts in malignant MCA stroke after DHC correlate well with the more meticulous methods.

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