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. 2023 Sep;165(9):2381-2387.
doi: 10.1007/s00701-023-05703-6. Epub 2023 Jul 18.

Cerebral perfusion changes in acute subdural hematoma

J Winkler  1 , G S Piedade  2   3 , C Rubbert  4 , B B Hofmann  1 , M A Kamp  5 , P J Slotty  1
Affiliations

Cerebral perfusion changes in acute subdural hematoma

J Winkler et al. Acta Neurochir (Wien). 2023 Sep.

Abstract

Introduction: Acute subdural hematoma (aSDH) is one of the main causes of high mortality and morbidity in traumatic brain injury. Prognosis is poor due to the rapid volume shift and mass effect. Cerebral perfusion is likely affected in this condition. This study quantifies perfusion changes in aSDH using early ER polytrauma CT with perfusion imaging (CTP).

Methods: Data of 54 patients with traumatic aSDH were retrospectively collected. Glasgow Coma scale (GCS), perfusion parameters, therapeutic decisions and imaging data including hematoma thickness, midline shift, and hematoma localization were analyzed. The cortical perfusion parameters of each hemisphere, the area anterior to the hematoma (AAH), area below the hematoma (ABH), area posterior to the hematoma (PAH), and corresponding mirrored contralateral regions were determined.

Results: We found a significant difference in Tmax in affected and unaffected whole-hemisphere data (mean 4.0 s vs. 3.3 s, p < 0.05) and a significantly different mean for Tmax in ABH and for the corresponding mirrored area (mABH) (mean 3.8 s vs. 3.1 s, p < 0.05). No significant perfusion changes in cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were found.

Conclusion: There was a significant elevation of time to maximum (Tmax) values in the underlying cortical area of aSDH. Possible pathophysiological explanations, the influence on immediate surgical decision-making and further therapeutic consequences have to be evaluated.

Keywords: Acute subdural hematoma; CT perfusion; Cerebral perfusion; Traumatic brain injury.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Native CT scan and identification of the analyzed areas
Fig. 2
Fig. 2
CTP of a patient with left hemispherical aSDH
Fig. 3
Fig. 3
Boxplots of the median CBF, CBV, Tmax, and MTT perfusion values measured in the whole brain and differentiated by age. In the middle aged group (40–65 years) exists an additional outlier value at CBF = 352.7 and CBV = 114.8. Both values are not included in the plots due to illustration purposes
See this image and copyright information in PMC

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