Individual variation of tentorial notch morphometry in a series of neurocritical patients

Abstract

Background: Cadaveric studies on humans have shown anatomical variabilities in the morphometric characteristics of the tentorial notch. These anatomical variations could influence the worsening of neurocritical patients. Objectives: 1) To investigate the morphometric characteristics of the tentorial notch in neurocritical patients using computed tomography (CT); 2) To investigate the correlation between tentorial notch measurements by CT and by magnetic resonance imaging (MRI); and 3) To analyze the individual variability of the tentorial notch anatomy seen in neurocritical patients. Methods: Prospective series of neurocritical patients was examined. An imaging protocol for measurements was designed for CT and MRI. The level of the agreement of the measurements from CT and MR images was established. According to the measurements found, patients were divided into different types of tentorial notch. Results: We studied 34 neurocritical patients by CT and MRI. Measurements of the tentorial notch via CT and MRI showed significant agreement: concordance correlation coefficient of 0.96 for notch length and 0.85 for maximum width of tentorial notch. Classification of tentorial notch measurements according to the criteria established by Adler and Milhorat, we found the following: 15 patients (58%) corresponded to a "short" subtype; 7 (21%) to "small"; 3 (9%) to "narrow"; 2 (6%) to "wide"; 2 (6%) to “large”; 1 (3%) to “long”; and 4 (12%) to "typical". Conclusions: The anatomical variability of the tentorial notch could be detected in vivo by means of CT scan and MRI. Good agreement between the measurements made using these two imaging methods was found.

Magnetic resonance based morphometric analysis of the tentorial notch

“…Despite the actual comprehension of the mechanism of the tentorial herniation, the reason for the clinical variation among patients is still unclear. The severity of the disease is determined mainly by the volume of the mass lesion, the localization, or the velocity of the pathological process [24]. In addition, the dimensions of the tentorial notch could have an implication on the clinical and severity of the brain herniation in patients with the same type of lesion [5,9].…”

“…Grille et al studied the characteristics of the tentorial notch in neurocritical patients. They described the "narrow," "short," and "small" as the most common types in neurocritical patients, which corresponded to wider and longer notch types [24]. Further studies comparing the characteristics in neurocritical patients are needed to determine the association between tentorial notch types and herniation patterns.…”