Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography
Abstract Only few studies have assessed brain shift caused by positional change. This study aimed to identify factors correlated with a large postneurosurgical positional brain shift (PBS). Sixty-seven patients who underwent neurosurgical procedures had upright computed tomography (CT) scan using se...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2022-06-01
|
| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-022-13276-0 |
| _version_ | 1818550487203446784 |
|---|---|
| author | Keisuke Yoshida Masahiro Toda Yoshitake Yamada Minoru Yamada Yoichi Yokoyama Kei Tsutsumi Hirokazu Fujiwara Kenzo Kosugi Masahiro Jinzaki |
| author_facet | Keisuke Yoshida Masahiro Toda Yoshitake Yamada Minoru Yamada Yoichi Yokoyama Kei Tsutsumi Hirokazu Fujiwara Kenzo Kosugi Masahiro Jinzaki |
| author_sort | Keisuke Yoshida |
| collection | DOAJ |
| description | Abstract Only few studies have assessed brain shift caused by positional change. This study aimed to identify factors correlated with a large postneurosurgical positional brain shift (PBS). Sixty-seven patients who underwent neurosurgical procedures had upright computed tomography (CT) scan using settings similar to those of conventional supine CT. The presence of a clinically significant PBS, defined as a brain shift of ≥ 5 mm caused by positional change, was evaluated. The clinical and radiological findings were investigated to identify factors associated with a larger PBS. As a result, twenty-one patients had a clinically significant PBS. The univariate analysis showed that supratentorial lesion location, intra-axial lesion type, craniectomy procedure, and residual intracranial air were the predictors of PBS. Based on the multivariate analysis, craniectomy procedure (p < 0.001) and residual intracranial air volume (p = 0.004) were the predictors of PBS. In a sub-analysis of post-craniectomy patients, PBS was larger in patients with supratentorial craniectomy site and parenchymal brain injury. A large craniectomy area and long interval from craniectomy were correlated with the extent of PBS. In conclusion, patients who undergo craniectomy and those with residual intracranial air can present with a large PBS. In post-craniectomy patients, the predisposing factors of a large PBS are supratentorial craniectomy, presence of parenchymal injury, large skull defect area, and long interval from craniectomy. These findings can contribute to safe mobilization among postneurosurgical patients and the risk assessment of sinking skin flap syndrome. |
| first_indexed | 2024-12-12T08:47:08Z |
| format | Article |
| id | doaj.art-2f4df5a31524431288da3e2d4bfa6010 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-12-12T08:47:08Z |
| publishDate | 2022-06-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-2f4df5a31524431288da3e2d4bfa60102022-12-22T00:30:29ZengNature PortfolioScientific Reports2045-23222022-06-011211910.1038/s41598-022-13276-0Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomographyKeisuke Yoshida0Masahiro Toda1Yoshitake Yamada2Minoru Yamada3Yoichi Yokoyama4Kei Tsutsumi5Hirokazu Fujiwara6Kenzo Kosugi7Masahiro Jinzaki8Department of Neurosurgery, Keio University School of MedicineDepartment of Neurosurgery, Keio University School of MedicineDepartment of Radiology, Keio University School of MedicineDepartment of Radiology, Keio University School of MedicineDepartment of Radiology, Keio University School of MedicineDepartment of Radiology, Keio University School of MedicineDepartment of Radiology, Keio University School of MedicineDepartment of Neurosurgery, Keio University School of MedicineDepartment of Radiology, Keio University School of MedicineAbstract Only few studies have assessed brain shift caused by positional change. This study aimed to identify factors correlated with a large postneurosurgical positional brain shift (PBS). Sixty-seven patients who underwent neurosurgical procedures had upright computed tomography (CT) scan using settings similar to those of conventional supine CT. The presence of a clinically significant PBS, defined as a brain shift of ≥ 5 mm caused by positional change, was evaluated. The clinical and radiological findings were investigated to identify factors associated with a larger PBS. As a result, twenty-one patients had a clinically significant PBS. The univariate analysis showed that supratentorial lesion location, intra-axial lesion type, craniectomy procedure, and residual intracranial air were the predictors of PBS. Based on the multivariate analysis, craniectomy procedure (p < 0.001) and residual intracranial air volume (p = 0.004) were the predictors of PBS. In a sub-analysis of post-craniectomy patients, PBS was larger in patients with supratentorial craniectomy site and parenchymal brain injury. A large craniectomy area and long interval from craniectomy were correlated with the extent of PBS. In conclusion, patients who undergo craniectomy and those with residual intracranial air can present with a large PBS. In post-craniectomy patients, the predisposing factors of a large PBS are supratentorial craniectomy, presence of parenchymal injury, large skull defect area, and long interval from craniectomy. These findings can contribute to safe mobilization among postneurosurgical patients and the risk assessment of sinking skin flap syndrome.https://doi.org/10.1038/s41598-022-13276-0 |
| spellingShingle | Keisuke Yoshida Masahiro Toda Yoshitake Yamada Minoru Yamada Yoichi Yokoyama Kei Tsutsumi Hirokazu Fujiwara Kenzo Kosugi Masahiro Jinzaki Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography Scientific Reports |
| title | Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography |
| title_full | Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography |
| title_fullStr | Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography |
| title_full_unstemmed | Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography |
| title_short | Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography |
| title_sort | cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift evaluation using upright computed tomography |
| url | https://doi.org/10.1038/s41598-022-13276-0 |
| work_keys_str_mv | AT keisukeyoshida cranialdefectandpneumocephalusareassociatedwithsignificantpostneurosurgicalpositionalbrainshiftevaluationusinguprightcomputedtomography AT masahirotoda cranialdefectandpneumocephalusareassociatedwithsignificantpostneurosurgicalpositionalbrainshiftevaluationusinguprightcomputedtomography AT yoshitakeyamada cranialdefectandpneumocephalusareassociatedwithsignificantpostneurosurgicalpositionalbrainshiftevaluationusinguprightcomputedtomography AT minoruyamada cranialdefectandpneumocephalusareassociatedwithsignificantpostneurosurgicalpositionalbrainshiftevaluationusinguprightcomputedtomography AT yoichiyokoyama cranialdefectandpneumocephalusareassociatedwithsignificantpostneurosurgicalpositionalbrainshiftevaluationusinguprightcomputedtomography AT keitsutsumi cranialdefectandpneumocephalusareassociatedwithsignificantpostneurosurgicalpositionalbrainshiftevaluationusinguprightcomputedtomography AT hirokazufujiwara cranialdefectandpneumocephalusareassociatedwithsignificantpostneurosurgicalpositionalbrainshiftevaluationusinguprightcomputedtomography AT kenzokosugi cranialdefectandpneumocephalusareassociatedwithsignificantpostneurosurgicalpositionalbrainshiftevaluationusinguprightcomputedtomography AT masahirojinzaki cranialdefectandpneumocephalusareassociatedwithsignificantpostneurosurgicalpositionalbrainshiftevaluationusinguprightcomputedtomography |