Estimation of prognosis in patients after decompressive craniectomy after malignant hemispheric infarction: multifactorial scoring scale.

BACKGROUND: Patient's age is considered to be one of the most relevant factors in selecting surgical candidates for decompressive hemicraniectomy after malignant hemispheric infarction. However, questions about surgical indication in older patients, patients with consciousness disorder or patients with large infarctions remain unanswered. OBJECTIVE: Our aim was to design a multifactorial scoring scale based on a combination of patient-specific factors in order to optimize the assessment of prognosis in patients after hemicraniectomy malignant strokes. METHODS: In this prospective observational study with a one-year follow-up, we assessed clinical and imaging data of patients who underwent decompressive hemicraniectomy due to malignant brain infarction. Barthel index was used as a single outcome measure to distinguish favorable vs. unfavorable outcomes. Associations between multiple variables and clinical outcome were assessed. Subsequently, a design of a predictive scoring system was proposed. RESULTS: Age of the patient, preoperative level of consciousness, midline shift, and volume of infarction showed a significant association with postoperative Barthel index. According to the identified factors, a multifactorial prognostic scoring system was introduced, aimed to distinguish between favorable and unfavorable outcomes. Using ROC analysis, it has achieved an AUC of 0.74 (95%CI 0.58‒0.89, p=0.01)CONCLUSIONS: Prediction of postoperative outcome should be based on multiple variables. Our scale, based on the clinical and imaging data, can be used during decision-making to estimate potential benefit of decompressive craniectomy in patients after malignant brain infarction (Tab. 5, Fig. 1, Ref. 32). Text in PDF www.elis.sk Keywords: decompressive hemicraniectomy, malignant hemispheric infarction, indication, outcome, prediction.

Non-acute subdural hematoma: estimation of recurrence using CT-volumetric measurements.

OBJECTIVES: To identify risk factors for unilateral non-acute subdural hematomas NASH recurrence, as well as to perform volumetric quantitative analysis of hematoma, postoperative pneumocephalus and extent of hematoma evacuation. BACKGROUND: Recurrence of NASH increases morbidity and mortality and has negative socio-economic consequences. Its accurate prediction could improve patient specific care. METHODS: Records of 102 patients after unilateral NASH evacuation during the period from 2014 to 2020 with a 4-month follow-up were evaluated. Impacts of preoperative clinical signs and factors on the incidence of NASH recurrence were evaluated, namely those of age, gender, timing of surgery, hematoma side, surgical technique (number of burr holes, trepanation versus craniotomy), duration of drainage, antithrombotic agents, morphological type of hematoma, preoperative hematoma volume (PHV), post-evacuation hematoma cavity volume (PHCV), pneumocephalus volume (PCV) and extent of hematoma evacuation (EHE) on the incidence of NASH recurrence were evaluated. RESULTS: An overall recurrence rate of 13.7 % was observed. Preoperative hematoma volume, postoperative hematoma cavity volume and postoperative pneumocephalus volume had a significant impact on incidence of recurrence. CONCLUSIONS: Pre- and postoperative volumetric evaluations, of patients with NASH, particularly the measurements of preoperative hematoma volume and postoperative volume of hematoma cavity and pneumocephalus have a potential to improve the prediction of clinically significant recurrence (Tab. 6, Fig. 3, Ref. 51). Text in PDF www.elis.sk Keywords: subdural hematoma, recurrence, pneumocephalus, risk factors.

Random Forest-Based Prediction of Outcome and Mortality in Patients with Traumatic Brain Injury Undergoing Primary Decompressive Craniectomy.

BACKGROUND: Various prognostic models are used to predict mortality and functional outcome in patients after traumatic brain injury with a trend to incorporate machine learning protocols. None of these models is focused exactly on the subgroup of patients indicated for decompressive craniectomy. Evidence regarding efficiency of this surgery is still incomplete, especially in patients undergoing primary decompressive craniectomy with evacuation of traumatic mass lesions. METHODS: In a prospective study with a 6-month follow-up period, we assessed postoperative outcome and mortality of 40 patients who underwent primary decompressive craniectomy for traumatic brain injuries during 2018-2019. The results were analyzed in relation to a wide spectrum of preoperatively available demographic, clinical, radiographic, and laboratory data. Random forest algorithms were trained for prediction of both mortality and unfavorable outcome, with their accuracy quantified by area under the receiver operating curves (AUCs) for out-of-bag samples. RESULTS: At the end of the follow-up period, we observed mortality of 57.5%. Favorable outcome (Glasgow Outcome Scale [GOS] score 4-5) was achieved by 30% of our patients. Random forest-based prediction models constructed for 6-month mortality and outcome reached a moderate predictive ability, with AUC = 0.811 and AUC = 0.873, respectively. Random forest models trained on handpicked variables showed slightly decreased AUC = 0.787 for 6-month mortality and AUC = 0.846 for 6-month outcome and increased out-of-bag error rates. CONCLUSIONS: Random forest algorithms show promising results in prediction of postoperative outcome and mortality in patients undergoing primary decompressive craniectomy. The best performance was achieved by Classification Random forest for 6-month outcome.

Change in sagittal profile after implantation of anchored interbody cage in the surgical procedure for degenerative cervical spine disease.

BACKGROUND: The aim of this study was to verify the relationship between changes in the segmental sagittal profile (SSP) and changes in the global sagittal profile (GSP) after anterior cervical discectomy with anchored cage implantation (ACDF). STUDY DESIGN: Prospective study with 2-year follow-up. METHODS: This study includes 104 patients after 1-level or 2-level ACDF operated between the May 2013 and March 2016. SSP was evaluated by Cobb angle measurement of operated motion segment (CobbS) and GSP was evaluated by Cobb angle measurement in C2-C7 segments (CobbG). Both SSP and GSP were measured pre- and postoperatively within a 24 months follow-up period. The influence of factors such as age, gender, number of treated segments and osteoporosis was evaluated using t-tests. The correlation between SSP and GSP changes was assessed by Pearson's correlation coefficient. RESULTS: In the early postoperative period after 1-level ACDF, there was a significantly greater increase in CobbS compared to that of the 2-level ACDF (P=0.0149). Male patients experienced a significant decrease of CobbG during the first 6 months after surgery as well as patients with osteoporosis within 12 months after ACDF. After ACDF the SSP change weakly correlated with the GSP change. CONCLUSION: SSP change after 1- or 2-level ACDF correlates mostly weakly with GSP change. Male gender and osteoporosis were identified as risk factors for global lordotisation following ACDF.

Incidence and risk factors of early postoperative complications in patients after decompressive craniectomy: a 5-year experience.

PURPOSE: Decompressive craniectomy is an effective measure to reduce a pathologically elevated intracranial pressure. Patients' survival and life quality following this surgery have been a subject of several studies and significantly differ according to the primary diagnosis. Since this operation is often associated with a wide spectrum of possibly serious complications, we aimed to describe their incidence and possible associated risk factors. METHODS: We evaluated 118 patients who underwent decompressive craniectomy at our clinic during years 2013-2017. The indications included traumatic brain injuries, ischaemic or haemorrhagic strokes and postoperative complications of planned neurosurgical procedures. Subsequently, we assessed the incidence of early postoperative complications (occurring during the first 3 postoperative weeks). The results were statistically analysed with relation to a wide selection of possible risk factors. RESULTS: At least one early surgical postoperative complication occurred in 87 (73.73%) patients, the most frequent being a development of an extraaxial fluid collection in 41 (34.75%) patients. We were able to identify risk factors linked with extraaxial fluid collections, subcutaneous and extradural haematomas, postoperative seizures and meningitis. An overall need for reoperation was 13.56%. Neither the duration of the surgery nor the qualification of the operating surgeon had any effect on the complications' occurrence. CONCLUSIONS: Decompressive craniectomy is associated with numerous early postoperative complications with a various degree of severity. Most cases of complications can, however, be managed in a conservative way. The risk factors linked with postoperative complications should be taken into account during the indication process in each individual patient.

Chronic calcified subdural hematoma - case report of a rare diagnosis.

INTRODUCTION: Chronic calcified/ossified subdural hematoma is a rare diagnosis. The incidence of chronic calcified subdural hematoma is 0.3-2.7% of all chronic subdural hematomas. Surgical treatment is indicated in most cases, but there is still some controversy. MATERIALS AND METHODS: We present a case report of 81-year-old woman with calcified chronic subdural hematoma. Patient underwent an osteoplastic left craniotomy, evacuation of chronic subdural mass with careful dissection andsuccessful removal of inner and outer membrane. Postoperative CT scan showed removal of subdural hematoma, decrease of left shift of median line and good brain re-expansion. Postoperative period was without any serious complications. RESULTS: Subdural hematoma was successfully removed, resulting in a good recovery with complete resolution of patients symptoms. From our experience, we highly recommend surgical treatment in cases of chronic symptomatic calcified subdural hematomas.