EFFACEMENT OF BASAL CISTERNS AS A SINGLE PROGNOSTIC FACTOR IN TRAUMATIC BRAIN INJURY

N AHMED; L REHMAN; MM SHARIF; A RAZA; N KHAN

doi:10.54112/bcsrj.v2024i1.1016

Authors

N AHMED Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
L REHMAN Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
MM SHARIF Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
A RAZA Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
N KHAN Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1016

Keywords:

Effacement, Patients, Basal, CT, CSF, TBI

Abstract

Effacement of basal cisterns, a condition characterized by the compression or obliteration of the cerebrospinal fluid (CSF)-filled spaces around the brainstem, is an essential radiological finding in the context of traumatic brain injury (TBI). Objectives: The study's primary purpose is to find the effacement of basal cisterns as a single prognostic factor in traumatic brain injury (TBI). Methods: This prospective observational study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, from June 2023 to May 2024. Data were collected from 250 patients suffering from TBI. For each patient, comprehensive demographic information, including age and gender, was recorded. Additional data included the mechanism of injury, the Glasgow Coma Scale (GCS) score at admission, and the presence of basal cistern effacement as observed on the initial CT scan. Radiological findings, such as midline shift and hematomas, were also documented. Results: The mean age of the patients was 35.6±5.65 years. There were 160 (64%) male and 90 (36%) female patients. Motor vehicle accidents were the most present form of injury 104 (41.6%). The mean GCS score at admission was 7.5 ± 2.1 in the basal cistern group and 12.3 ± 2.8 in the no basal cistern group. The study results revealed a significant association between basal cistern effacement and midline shift, with 61.5% of patients with effacement showing midline shift compared to only 14.8% without effacement (p < 0.01). Conclusion: Basal cistern effacement on initial CT scans is a significant prognostic indicator in traumatic brain injury. Its presence is associated with more severe injury, higher necessity for surgical intervention, and poorer long-term outcomes.

Downloads

Download data is not yet available.

References

Yu H, Ande SR, Batoo D, Linton J, Shankar J. Prognostic Value of Initial Diagnostic Imaging Findings for Patient Outcomes in Adult Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Tomography. 2023 Feb 24;9(2):509-528. doi: 10.3390/tomography9020042. PMID: 36961001; PMCID: PMC10037627.

Byrnes K.R., Wilson C.M., Brabazon F., Von Leden R., Jurgens J.S., Oakes T.R., Selwyn R.G. FDG-PET imaging in mild traumatic brain injury: A critical review. Front. Neuroenerget. 2014;5:13. doi: 10.3389/fnene.2013.00013.

Fatima N., Shuaib A., Chughtai T., Ayyad A., Saqqur M. The role of transcranial doppler in traumatic brain injury: A systemic review and meta-analysis. Asian J. Neurosurg. 2019;14:626–633. doi: 10.4103/ajns.AJNS_42_19.

Haghbayan H., Boutin A., Laflamme M., Lauzier F., Shemilt M., Moore L., Zarychanski R., Douville V., Fergusson D., Turgeon A.F. The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Crit. Care Med. 2017;45:e1280–e1288. doi: 10.1097/CCM.0000000000002731

Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., Shamseer L., Tetzlaff J.M., Akl E.A., Brennan S.E., et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: 10.1136/bmj.n71.

Noma H., Matsushima Y., Ishii R. Confidence interval for the AUC of SROC curve and some related methods using bootstrap for meta-analysis of diagnostic accuracy studies. Commun. Stat. Case Stud. Data Anal. Appl. 2021;7:344–358. doi: 10.1080/23737484.2021.1894408.

Henninger N., Compton R.A., Khan M.W., Carandang R., Hall W., Muehlschlegel S. “Don’t lose hope early”: Hemorrhagic diffuse axonal injury on head computed tomography is not associated with poor outcome in moderate to severe traumatic brain injury patients. J. Trauma Inj. Infect. Crit. Care. 2018;84:473–482. doi: 10.1097/TA.0000000000001733.

Kreitzer N., Hart K., Lindsell C.J., Betham B., Gozal Y., Andaluz N.O., Lyons M.S., Bonomo J., Adeoye O. Factors associated with adverse outcomes in patients with traumatic intracranial hemorrhage and Glasgow Coma Scale of 15. Am. J. Emerg. Med. 2017;35:875–880. doi: 10.1016/j.ajem.2017.01.051.

Shankar J.J.S., Green R., Virani K., Wong H., Eddy K., Vandorpe R. Admission Perfusion CT for Classifying Early In-Hospital Mortality of Patients With Severe Traumatic Brain Injury: A Pilot Study. Am. J. Roentgenol. 2020;214:872–876. doi: 10.2214/AJR.19.21599

Tucker B., Aston J., Dines M., Caraman E., Yacyshyn M., McCarthy M., Olson J.E. Early Brain Edema is a Predictor of In-Hospital Mortality in Traumatic Brain Injury. J. Emerg. Med. 2017;53:18–29. doi: 10.1016/j.jemermed.2017.02.010.

Yamamura H., Morioka T., Yamamoto T., Mizobata Y. Head computed tomographic measurement as a predictor of outcome in patients with subdural hematoma with cerebral edema. Scand. J. Trauma Resusc. Emerg. Med. 2016;24:83. doi: 10.1186/s13049-016-0271-y.

Carney N., Totten A.M., O’Reilly C., Ullman J.S., Hawryluk G.W.J., Bell M.J., Bratton S.L., Chesnut R., Harris O.A., Kissoon K.N., et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80:6–15. doi: 10.1227/NEU.0000000000001432

Fatima, N., Mohamed, M. E., De Leon, A., El Beltagi, A., Shuaib, A., & Saqqur, M. (2020). Comparative Radiographic Factors Predicting Functional Outcome After Decompressive Craniectomy in Severe Traumatic Brain Injury. World Neurosurgery, 138, e876-e882. https://doi.org/10.1016/j.wneu.2020.03.118

Toledo JA, Namias R Sr, Milano MJ. A Novel Automated Calculation of Basal Cistern Effacement Status on Computed Tomographic Imaging in Traumatic Brain Injury. Cureus. 2021 Feb 5;13(2):e13144. doi: 10.7759/cureus.13144. PMID: 33692917; PMCID: PMC7937044.

Golden, N., Mardhika, P. E., Niryana, W., Sukarya, I. M., & Prabawa, I. P. Y. (2020). Risk factors and novel prognostic score for predicting the 14-day mortality of severe traumatic brain injury patients. Intisari Sains Medis, 11(3), 1020-1028.

Juskys, R., Vilcinis, R., Piliponis, L., & Tamasauskas, A. (2023). Degree of basal cisterns compression predicting mortality and functional outcome after craniotomy and primary decompressive craniectomy in acute subdural hematoma population. Acta Neurochirurgica, 165(12), 4013-4020.

Hong, J. H., Jeon, I., Seo, Y., Kim, S. H., & Yu, D. (2021). Radiographic predictors of clinical outcome in traumatic brain injury after decompressive craniectomy. Acta Neurochirurgica, 163, 1371-1381.

Yeole, U., Krishnakumar, M., Gopalakrishna, K. N., Sekar, A., Sadashiva, N., & Shukla, D. (2020). Surgical outcomes in traumatic brain injuries with bilateral mass occupying lesions. Analysis of prognostic factors. Clinical Neurology and Neurosurgery, 196, 106017.