Does the skull Hounsfield unit predict shunt dependent hydrocephalus after decompressive craniectomy for traumatic acute subdural hematoma?

Abstract

Background and purposePosttraumatic hydrocephalus affects 11.9%-36% of patients undergoing decompressive craniectomy (DC) after traumatic brain injury and necessitates a ventriculo-peritoneal shunt placement. As bone and arachnoid trabeculae share the same collagen type, we investigated possible connections between the skull Hounsfield unit (HU) values and shunt-dependent hydrocephalus (SDHC) in patients that received cranioplasty after DC for traumatic acute subdural hematoma (SDH). MethodsWe measured HU values in the frontal bone and internal occipital protuberance from admission brain CT. Receiver operating characteristic curve analysis was performed to identify the optimal cut-off skull HU values for predicting SDHC in patients receiving cranioplasty after DC due to traumatic acute SDH. We investigated independent predictive factors for SDHC occurrence using multivariable logistic regression analysis. ResultsA total of 162 patients (>15 years of age) were enrolled in the study over an 11-year period from two university hospitals. Multivariable logistic analysis revealed that the group with simultaneous frontal skull HU �797.4 and internal occipital protuberance HU �586.5 (odds ratio, 8.57; 95% CI, 3.05 to 24.10; P<0.001) was the only independent predictive factor for SDHC in patients who received cranioplasty after DC for traumatic acute SDH. ConclusionsOur study reveals a potential relationship between possible low bone mineral density and development of SDHC in traumatic acute SDH patients who had undergone DC. Our

Change of Levels of NGF, ACTH, and AVP in the Cerebrospinal Fluid after Decompressive Craniectomy of Craniocerebral Injury and Their Relationship with Communicating Hydrocephalus

“…In our study, the incidence of communicating hydrocephalus was 30.39%, which was within the range of the abovementioned incidence of traumatic hydrocephalus. DC was significantly correlated with postoperative hydrocephalus [17,18]. e reason is that, after decompressive craniectomy, the skull loses its protective effect, the volume in the skull cavity is unstable, and the normal intracranial pressure balance is destroyed, which affects the CSF pressure, deforms the ventricle, affects the hemodynamics, and finally, affects the generation and absorption of hydrocephalus [19].…”

“…Monitoring the levels of NGF, ACTH, and AVP is of great significance for clinicians to judge the occurrence of traffic hydrocephalus, evaluate the prognosis of patients with craniocerebral injury after DC, and guide clinical treatment. [17]…”

The “Mascara Sign”: Can Hounsfield Unit Help Diagnose Proximal Ventriculoperitoneal Shunt Malfunction in Paediatric Population?

“…Birnbaum BA et al reported that there are variations in Hounsfield values between scanners including Philips and Siemens, however this is very minute (range 0-20 HU). 36 In addition, there is the caveat of interobserver bias whilst selecting the exact points for Hounsfield measurement. To account for this bias, In Suk Bae et al recommends an oval function called 'Region of Interest (ROI)' whereby the maximum, minimum and mean HU values can be automatically obtained by the PACS system.…”