Transcranial color-coded duplex sonography for evaluation of midline-shift after chronic-subdural hematoma evacuation (TEMASE): A prospective study

Autori:Andrea Cattalani, Vincenzo Maria Grasso, Matteo Vitali, Ivan Gallesio, Lorenzo Magrassi, Andrea Barbanera
Pubblicato su:Clinical Neurology and Neurosurgery 162 (2017) 101–107

Presentazione

In questo interessante studio le neurochirurgie di Alessandria e di Pavia  propongono l’utilizzo del ecocolordoppler transcarnico per la il monitoraggio e la valutazione dello spostamento delle strutture della linea mediana negli ematomi  ematomi sottodurali cronici, dimostrandone elegantemente la riproducibilità e l'efficacia al letto del paziente. 

Abstract

Objective: The incidence of chronic Subdural hematoma (cSDH) is increasing and its rate of recurrence varies from 5 to 33%. A postoperative brain midline-shift (MLS) on computed tomography (CT) equal or larger than 5 mm is a risk factor for recurrence. Transcranial color-coded duplex sonography (TCCDS) is a noninvasive bedside reproducible technique useful to detect MLS. The aim of our study was to compare in patients affected by cSDH, the values of MLS obtained pre- and post-operatively by TCCDS and brain CT.

Patients and methods: 32 patients affected by cSDH entered the study between July 2016 and January 2017. MLS values obtained by TCCDS and brain CT were compared using Bland-Altman plot and linear regression analysis. Using the same techniques we also explored if the agreement between the two imaging modes was comparable in pre- and post-operative data pairs.

Results: 64 data pairs of MLS values obtained by TCCDS and CT were analysed. Bland-Altman diagrams did not show any systematic bias of the data and linear regression indicated a significant correlation between the two measures both before and after hematoma evacuation.
Conclusion: In patients affected by cSDH, MLS values obtained before and after surgery by TCCDS are com- parable to those obtained by CT; TCCDS might be considered an alternative to CT scan in the management of patients after cSDH evacuation. We suggest that close clinical bedside examination and TCCDS might be ap- propriate for the post-operative management of cSDH, reserving CT scan only to patients with overt clinical deterioration and/or increasing MLS.

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