Lateral Ventricle Volume Asymmetry Predicts Midline Shift in Severe Traumatic Brain Injury.
Midline shift following severe traumatic brain injury (sTBI) detected on computed tomography (CT) scans is an established predictor of poor outcome. We hypothesized that lateral ventricular volume (LVV) asymmetry is an earlier sign of developing asymmetric intracranial pathology than midline shift. This retrospective analysis was performed on data from 84 adults with blunt sTBI requiring a ventriculostomy who presented to a Level I trauma center. Seventy-six patients underwent serial CTs within 3 h and an average of three scans within the first 10 d of sTBI. Left and right LVVs were quantified by computer-assisted manual volumetric measurements. LVV ratios (LVR) were determined on the admission CT to evaluate ventricular asymmetry. The relationship between the admission LVR value and subsequent midline shift development was tested using receiver operating characteristic (ROC) analysis, and odds ratio (OR) and relative risk tests. Sixty patients had no >5 mm midline shift on the initial admission scan. Of these, 15 patients developed it subsequently (16 patients already had >5 mm midline shift on admission scans). For >5 mm midline shift development, admission LVR of >1.67 was shown to have a sensitivity of 73.3% and a specificity of 73.3% (area under the curve=0.782; p<0.0001). LVR of >1.67 as exposure yielded an OR of 7.56 (p<0.01), and a risk ratio of 4.42 (p<0.01) for midline shift development as unfavorable outcome. We propose that LVR captures LVV asymmetry and is not only related to, but also predicts the development of midline shift already at admission CT examination. Lateral ventricles may have a higher "compliance" than midline structures to developing asymmetric brain pathology. LVR analysis is simple, rapidly accomplished and may allow earlier interventions to attenuate midline shift and potentially improve ultimate outcomes.
1 Department of Neurosurgery, University of Pécs , Pécs, Hungary .
Arnold
A
Tóth
2 Department of Radiology, University of Florida , Gainesville, Florida.|3 North Florida/South Georgia Veterans Administration , Gainesville, Florida.
Ilona
I
Schmalfuss
4 Department of Clinical and Health Psychology, University of Florida , Gainesville, Florida.
Shelley C
SC
Heaton
5 Department of Anesthesiology and Critical Care, University of Florida , Gainesville, Florida.
Andrea
A
Gabrielli
6 Department of Psychology, University of Houston , Houston, Texas.
H Julia
HJ
Hannay
7 Orlando Regional Medical Center , Orlando, Florida.
Linda
L
Papa
8 Department of Pharmacotherapy and Outcomes Science and Neurosurgery, Virginia Commonwealth University , Richmond, Virginia.
Gretchen M
GM
Brophy
9 Center for Neuroproteomics and Biomarkers Research Departments of Psychiatry and Neuroscience McKnight Brain Institute, University of Florida , Gainesville, Florida.
Kevin K W
KK
Wang
1 Department of Neurosurgery, University of Pécs , Pécs, Hungary .
András
A
Büki
1 Department of Neurosurgery, University of Pécs , Pécs, Hungary .
Attila
A
Schwarcz
10 Banyan Biomarkers, Inc., Alachua, Florida.
Ronald L
RL
Hayes
11 Department of Neurosurgery, Baylor College of Medicine , Houston, Texas.
Claudia S
CS
Robertson
12 Departments of Anesthesiology and Neuroscience, University of Florida , Gainesville, Florida.
Steven A
SA
Robicsek
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D020547:Lateral Ventricles / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult
computed tomography; midline shift; traumatic brain injury; ventricle