A standardized method to measure brain shifts with decompressive hemicraniectomy.
A standardized, reliable, and practical method for measuring decompressive hemicraniectomy (DHC) defects and brain shifts in malignant middle cerebral artery (MCA) territory infarction is needed for reliable comparisons between computed tomography (CT) scans. Such a method could facilitate further studies on the effects of DHC.



We describe and apply a method for measuring DHC defects and brain shifts on CT scans in 25 patients with malignant MCA territory infarction. Craniectomy area is adjusted for variations in head size, CT slice orientation is standardized, and the site of each measurement is defined. This method uses standard radiology platforms and volume-acquired helical CT scans.



The measurements include a DHC size index (adjusted for variations in head size), midline brain shift (subfalcine), outward brain herniation (transcalvarial), and the diameter of the contralateral atrium of the lateral ventricle. Inter-rater agreement for these measurements in a sample of 15 subjects is excellent (correlation coefficients 0.90-0.98).



In contrast to previously reported methods, this method is tested in acute stroke patients, compensates for variability in head size, and includes a midline brain shift (subfalcine) and brain ventricular system measurements.



A practical method for measuring DHC size and brain shifts designed to be consistent between scans is proposed. This method should facilitate comparisons of measurements between serial scans, between patients, and perhaps between studies. This method could be useful in medical and surgical studies of brain herniations in malignant MCA territory infarction, and possibly other conditions.
Department of Neurology, Medical College of Georgia at Augusta University, Augusta, Georgia. Electronic address: abruno@augusta.edu.
Askiel
A
Bruno
Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia.
Abdurrehman
A
Zahran
School of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
Nina
N
Paletta
Department of Neurology, Medical College of Georgia at Augusta University, Augusta, Georgia.
Laith
L
Maali
Department of Neurology, Medical College of Georgia at Augusta University, Augusta, Georgia.
Fenwick T
FT
Nichols
Department of Radiology, Medical College of Georgia at Augusta University, Augusta, Georgia.
Ramon
R
Figueroa
D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D056424:Decompressive Craniectomy / Q000592:standards; D004677:Encephalocele / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards*
Brain herniation; Hemicraniectomy; Ischemic brain edema; Ischemic stroke