J Korean Neurotraumatol Soc.  2008 Dec;4(2):70-76. 10.13004/jknts.2008.4.2.70.

The Relationship between Postoperative Drainage Volume and Brain Shifting Index in Chronic Subdural Hematoma

• Oh CH
• Hyun DK
• Yoon SH
• Park HS
• Kim E
• Park HC
• Park CO

• KMID: 2156153
• DOI: http://doi.org/10.13004/jknts.2008.4.2.70

Abstract

OBJECTIVE
It is still unclear to predict the postoperative drainage volume of chronic subdural hematoma (CSDH) and the relation between the degree of brain shifting and the postoperative drainage volume, even CSDH is relatively common disease. In this study, the authors evaluate the relationship between the brain shifting index and the postoperative drainage volume, and investigated the influencing factors associated with the postoperative drainage volume in CSDH.
METHODS
Fifty-eight CSDH with 45 patients, who were operated from November 2003 to April 2006, were enrolled. We investigated multiple factors associated with CSDH including the hemorrhage density and measured the parameters about the brain compliance on computed tomography (CT) as it followed (A, the distance between both inner skull table at the level of frontal horn of lateral ventricle; B, the distance between the most medial side of caudate nucleus head and the ipsilateral inner skull table at the same level of the parameter A; C, the distance of midline shifting at the level of third ventricle; D, the largest thickness of chronic subdural hematoma). We estimated the brain shifting index using the degree of frontal horn compression and midline shifting by the B/A or C/D ratios and the statistical analysis for the relation with the postoperative drainage volume was done.
RESULTS
The mean age was 63.8+/-25.2 years and mean drainage volume was about 248.8+/-173.2 mL. Mean drainage date was 5.9+/-1.5 days and the daily drainage volumes were 109.5, 50.9, 22.2, 14.4, 15.8 mL respectively. The postoperative drainage volume of CSDH was significant correlated with the density of CSDH in brain CT (p=0.04), and the postoperative drainage volume was decreased as the B/A ratio increased (r=0.299, p=0.023).
CONCLUSION
The postoperative drainage volume in CSDH was affected by brain expansion. The density types of CSDH and the brain shifting index which were presenting the degree of frontal horn compression may helpful to predict the postoperative drainage volume in CSDH.

Keyword

Chronic subdural hematoma; Drainage volume; Brain shifting index; Computed tomography

MeSH Terms

Animals
Brain
Caudate Nucleus
Compliance
Drainage
Head
Hematoma, Subdural, Chronic
Hemorrhage
Horns
Humans
Skull

Figure

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  FIGURE 1 Parameters to estimate the brain shifting index of CSDH. A: The distance between both inner skull table at the level of frontal horn of lateral ventricle. B: The distance between most medial side of caudate nucleus head and the ipsilateral inner skull table at the same level of the parameter A. C: The distance of midline shifting at the level of third ventricle. D: The largest thickness of chronic subdural hematoma. CSDH: chronic subdural hematoma.

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  FIGURE 2 The relation between the B/A ratio, brain shifting index, and the postoperative drainage volume of CSDH. Using the regression analysis, the correlation coefficient was 0.29915, and the line of tendency was checked as 'Postoperative drainage volume=-904.3×B/A ratio+757.4' (p-value=0.022538). This means that the postoperative drainage volume increase as the brain shifting index B/A ratio decreased. B/A: the ratio of the distance between the most medial side of caudate nucleus head and the ipsilateral inner skull table (B) over the distance between both inner skull table at the level of frontal horn of lateral ventricle at the same level (A), CSDH: chronic subdural hematoma.

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  FIGURE 3 The relation between the C/D ratio, brain shifting index, and the postoperative drainage volume of CSDH. Using the regression analysis, the correlation coefficient was 0.164047, and the line of tendency was checked as 'Postoperative drainage volume=-123.2×C/D ratio+359.9' (p-value=0.218509). This means that the postoperative drainage volume was not correlated with the brain shifting index C/D ration in statistic analysis. C/D: the ration of the distance of midline shifting at the level of third ventricle (C) over the largest thickness of chronic subdural hematoma (D), CSDH: chronic subdural hematoma.

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  FIGURE 4 The comparison of the B/A and C/D ratios, brain shifting indexes, on brain CT imaging on the basis of drainage volume (200 mL) of CSDH. The B/A and C/D ratios, brain shifting indexes, on brain CT imaging on the basis of 200 mL CSDH drainage volume was shown (p<0.05). The brain shifting index B/A ratio is 0.5202 in the drainage volume lesser than 200 mL and it was decreased to 0.4932 in the drainage volume more than 200 mL. Also the brain shifting index C/D ratio was decreased from 0.5652 to 0.4932 as the drainage volume was increased from the lesser than 200 mL to the more than 200 mL. CSDH: chronic subdural hematoma, B/A: the ratio of the distance between the most medial side of caudate nucleus head and the ipsilateral inner skull table (B) over the distance between both inner skull table at the level of frontal horn of lateral ventricle at the same level (A). C/D: the ration of the distance of midline shifting at the level of third ventricle (C) over the largest thickness of chronic subdural hematoma (D).

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