Preoperative brain shift is a prognostic factor for survival in certain neurosurgical diseases other than severe head injury: a case series and literature review.

ABSTRACT

Preoperative brain shift after severe brain injury is a prognostic factor for survival. The aim of this study was to determine whether preoperative brain shift in conditions other than severe head injury has significant prognostic value. We analyzed a radiological database of 800 consecutive patients, who underwent neurosurgical treatment. Brain shift was measured at two anatomical landmarks Monro's foramina (MF) and the corpus callosum (CC). Four hundred seventy-three patients were included. The disease exerting the highest mean brain shift was acute subdural hematoma (MF 11.6 mm, CC 12.4 mm), followed by intraparenchymal hematoma (MF 10.2 mm, CC 10.3 mm) and malignant ischemia (MF 10.4 mm, CC 10.5 mm). On univariate analysis, brain shift was a significant negative factor for survival in all diseases (p < 0.001). Analyzed individually by group, brain shift at both anatomical landmarks had a statistically significant effect on survival in malignant ischemia and at one anatomical landmark in chronic subdural and intraparenchymal hematomas. Multivariate analysis demonstrated that the only independent factor negatively impacting survival was brain shift at MF (OR = 0.89; 95% CI 0.84-0.95) and CC (OR = 0.90; 95% CI 0.85-0.96). Brain shift is a prognostic factor for survival in patients with expansive intracranial lesions in certain neurosurgical diseases. MF and CC are reliable anatomical landmarks and should be quoted routinely in radiological reports as well as in neurosurgical practice.