A new improved method for assessing brain deformation after decompressive craniectomy
Decompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure. However the clinical effectiveness of the intervention remains in doubt. The location of the craniectomy (unilateral or bifrontal) might be expected t...
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Published in | PloS one Vol. 9; no. 10; p. e110408 |
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Abstract | Decompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure. However the clinical effectiveness of the intervention remains in doubt. The location of the craniectomy (unilateral or bifrontal) might be expected to change the brain deformation associated with the operation and hence the clinical outcome. As existing methods for assessing brain deformation have several limitations, we sought to develop and validate a new improved method.
Computed tomography (CT) scans were taken from 27 patients who underwent DC (17 bifrontal patients and 10 unilateral patients). Pre-operative and post-operative images were processed and registered to determine the change in brain position associated with the operation. The maximum deformation in the herniated brain, the change in volume and estimates of the craniectomy area were determined from the images. Statistical comparison was made using the Pearson's correlation coefficient r and a Welch's two-tailed T-test, with statistical significance reported at the 5% level.
There was a reasonable correlation between the volume increase and the maximum brain displacement (r = 0.64), a low correlation between the volume increase and the craniectomy area (r = 0.30) and no correlation between the maximum displacement and the craniectomy area (r = -0.01). The maximum deformation was significantly lower (P = 0.023) in the bifrontal patients (mean = 22.5 mm) compared with the unilateral patients (mean = 29.8 mm). Herniation volume was significantly lower (P = 0.023) in bifrontal (mean = 50.0 ml) than unilateral patients (mean = 107.3 ml). Craniectomy area was not significantly different for the two craniectomy locations (P = 0.29).
A method has been developed to quantify changes in brain deformation due to decompressive craniectomy from CT images and allow comparison between different craniectomy locations. Measured displacement is a reasonable way to characterise volume changes. |
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AbstractList | Background Decompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure. However the clinical effectiveness of the intervention remains in doubt. The location of the craniectomy (unilateral or bifrontal) might be expected to change the brain deformation associated with the operation and hence the clinical outcome. As existing methods for assessing brain deformation have several limitations, we sought to develop and validate a new improved method. Methods Computed tomography (CT) scans were taken from 27 patients who underwent DC (17 bifrontal patients and 10 unilateral patients). Pre-operative and post-operative images were processed and registered to determine the change in brain position associated with the operation. The maximum deformation in the herniated brain, the change in volume and estimates of the craniectomy area were determined from the images. Statistical comparison was made using the Pearson’s correlation coefficient r and a Welch’s two-tailed T-test, with statistical significance reported at the 5% level. Results There was a reasonable correlation between the volume increase and the maximum brain displacement (r = 0.64), a low correlation between the volume increase and the craniectomy area (r = 0.30) and no correlation between the maximum displacement and the craniectomy area (r = −0.01). The maximum deformation was significantly lower (P = 0.023) in the bifrontal patients (mean = 22.5 mm) compared with the unilateral patients (mean = 29.8 mm). Herniation volume was significantly lower (P = 0.023) in bifrontal (mean = 50.0 ml) than unilateral patients (mean = 107.3 ml). Craniectomy area was not significantly different for the two craniectomy locations (P = 0.29). Conclusions A method has been developed to quantify changes in brain deformation due to decompressive craniectomy from CT images and allow comparison between different craniectomy locations. Measured displacement is a reasonable way to characterise volume changes. BackgroundDecompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure. However the clinical effectiveness of the intervention remains in doubt. The location of the craniectomy (unilateral or bifrontal) might be expected to change the brain deformation associated with the operation and hence the clinical outcome. As existing methods for assessing brain deformation have several limitations, we sought to develop and validate a new improved method.MethodsComputed tomography (CT) scans were taken from 27 patients who underwent DC (17 bifrontal patients and 10 unilateral patients). Pre-operative and post-operative images were processed and registered to determine the change in brain position associated with the operation. The maximum deformation in the herniated brain, the change in volume and estimates of the craniectomy area were determined from the images. Statistical comparison was made using the Pearson's correlation coefficient r and a Welch's two-tailed T-test, with statistical significance reported at the 5% level.ResultsThere was a reasonable correlation between the volume increase and the maximum brain displacement (r = 0.64), a low correlation between the volume increase and the craniectomy area (r = 0.30) and no correlation between the maximum displacement and the craniectomy area (r = -0.01). The maximum deformation was significantly lower (P = 0.023) in the bifrontal patients (mean = 22.5 mm) compared with the unilateral patients (mean = 29.8 mm). Herniation volume was significantly lower (P = 0.023) in bifrontal (mean = 50.0 ml) than unilateral patients (mean = 107.3 ml). Craniectomy area was not significantly different for the two craniectomy locations (P = 0.29).ConclusionsA method has been developed to quantify changes in brain deformation due to decompressive craniectomy from CT images and allow comparison between different craniectomy locations. Measured displacement is a reasonable way to characterise volume changes. Background Decompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure. However the clinical effectiveness of the intervention remains in doubt. The location of the craniectomy (unilateral or bifrontal) might be expected to change the brain deformation associated with the operation and hence the clinical outcome. As existing methods for assessing brain deformation have several limitations, we sought to develop and validate a new improved method. Methods Computed tomography (CT) scans were taken from 27 patients who underwent DC (17 bifrontal patients and 10 unilateral patients). Pre-operative and post-operative images were processed and registered to determine the change in brain position associated with the operation. The maximum deformation in the herniated brain, the change in volume and estimates of the craniectomy area were determined from the images. Statistical comparison was made using the Pearson's correlation coefficient r and a Welch's two-tailed T-test, with statistical significance reported at the 5% level. Results There was a reasonable correlation between the volume increase and the maximum brain displacement (r = 0.64), a low correlation between the volume increase and the craniectomy area (r = 0.30) and no correlation between the maximum displacement and the craniectomy area (r = -0.01). The maximum deformation was significantly lower (P = 0.023) in the bifrontal patients (mean = 22.5 mm) compared with the unilateral patients (mean = 29.8 mm). Herniation volume was significantly lower (P = 0.023) in bifrontal (mean = 50.0 ml) than unilateral patients (mean = 107.3 ml). Craniectomy area was not significantly different for the two craniectomy locations (P = 0.29). Conclusions A method has been developed to quantify changes in brain deformation due to decompressive craniectomy from CT images and allow comparison between different craniectomy locations. Measured displacement is a reasonable way to characterise volume changes. Decompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure. However the clinical effectiveness of the intervention remains in doubt. The location of the craniectomy (unilateral or bifrontal) might be expected to change the brain deformation associated with the operation and hence the clinical outcome. As existing methods for assessing brain deformation have several limitations, we sought to develop and validate a new improved method. Computed tomography (CT) scans were taken from 27 patients who underwent DC (17 bifrontal patients and 10 unilateral patients). Pre-operative and post-operative images were processed and registered to determine the change in brain position associated with the operation. The maximum deformation in the herniated brain, the change in volume and estimates of the craniectomy area were determined from the images. Statistical comparison was made using the Pearson's correlation coefficient r and a Welch's two-tailed T-test, with statistical significance reported at the 5% level. There was a reasonable correlation between the volume increase and the maximum brain displacement (r = 0.64), a low correlation between the volume increase and the craniectomy area (r = 0.30) and no correlation between the maximum displacement and the craniectomy area (r = -0.01). The maximum deformation was significantly lower (P = 0.023) in the bifrontal patients (mean = 22.5 mm) compared with the unilateral patients (mean = 29.8 mm). Herniation volume was significantly lower (P = 0.023) in bifrontal (mean = 50.0 ml) than unilateral patients (mean = 107.3 ml). Craniectomy area was not significantly different for the two craniectomy locations (P = 0.29). A method has been developed to quantify changes in brain deformation due to decompressive craniectomy from CT images and allow comparison between different craniectomy locations. Measured displacement is a reasonable way to characterise volume changes. Decompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure. However the clinical effectiveness of the intervention remains in doubt. The location of the craniectomy (unilateral or bifrontal) might be expected to change the brain deformation associated with the operation and hence the clinical outcome. As existing methods for assessing brain deformation have several limitations, we sought to develop and validate a new improved method. Computed tomography (CT) scans were taken from 27 patients who underwent DC (17 bifrontal patients and 10 unilateral patients). Pre-operative and post-operative images were processed and registered to determine the change in brain position associated with the operation. The maximum deformation in the herniated brain, the change in volume and estimates of the craniectomy area were determined from the images. Statistical comparison was made using the Pearson's correlation coefficient r and a Welch's two-tailed T-test, with statistical significance reported at the 5% level. There was a reasonable correlation between the volume increase and the maximum brain displacement (r = 0.64), a low correlation between the volume increase and the craniectomy area (r = 0.30) and no correlation between the maximum displacement and the craniectomy area (r = -0.01). The maximum deformation was significantly lower (P = 0.023) in the bifrontal patients (mean = 22.5 mm) compared with the unilateral patients (mean = 29.8 mm). Herniation volume was significantly lower (P = 0.023) in bifrontal (mean = 50.0 ml) than unilateral patients (mean = 107.3 ml). Craniectomy area was not significantly different for the two craniectomy locations (P = 0.29). A method has been developed to quantify changes in brain deformation due to decompressive craniectomy from CT images and allow comparison between different craniectomy locations. Measured displacement is a reasonable way to characterise volume changes. Background Decompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure. However the clinical effectiveness of the intervention remains in doubt. The location of the craniectomy (unilateral or bifrontal) might be expected to change the brain deformation associated with the operation and hence the clinical outcome. As existing methods for assessing brain deformation have several limitations, we sought to develop and validate a new improved method. Methods Computed tomography (CT) scans were taken from 27 patients who underwent DC (17 bifrontal patients and 10 unilateral patients). Pre-operative and post-operative images were processed and registered to determine the change in brain position associated with the operation. The maximum deformation in the herniated brain, the change in volume and estimates of the craniectomy area were determined from the images. Statistical comparison was made using the Pearson’s correlation coefficient r and a Welch’s two-tailed T -test, with statistical significance reported at the 5% level. Results There was a reasonable correlation between the volume increase and the maximum brain displacement ( r = 0.64), a low correlation between the volume increase and the craniectomy area ( r = 0.30) and no correlation between the maximum displacement and the craniectomy area ( r = −0.01). The maximum deformation was significantly lower ( P = 0.023) in the bifrontal patients (mean = 22.5 mm) compared with the unilateral patients (mean = 29.8 mm). Herniation volume was significantly lower ( P = 0.023) in bifrontal (mean = 50.0 ml) than unilateral patients (mean = 107.3 ml). Craniectomy area was not significantly different for the two craniectomy locations ( P = 0.29). Conclusions A method has been developed to quantify changes in brain deformation due to decompressive craniectomy from CT images and allow comparison between different craniectomy locations. Measured displacement is a reasonable way to characterise volume changes. |
Audience | Academic |
Author | Sutcliffe, Michael P F Fletcher, Tim L Kolias, Angelos G Hutchinson, Peter J |
AuthorAffiliation | 1 Department of Engineering, University of Cambridge, Cambridge, United Kingdom University of Nebraska Medical Center, United States of America 2 Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom |
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Author_xml | – sequence: 1 givenname: Tim L surname: Fletcher fullname: Fletcher, Tim L organization: Department of Engineering, University of Cambridge, Cambridge, United Kingdom – sequence: 2 givenname: Angelos G surname: Kolias fullname: Kolias, Angelos G organization: Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom – sequence: 3 givenname: Peter J surname: Hutchinson fullname: Hutchinson, Peter J organization: Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom – sequence: 4 givenname: Michael P F surname: Sutcliffe fullname: Sutcliffe, Michael P F organization: Department of Engineering, University of Cambridge, Cambridge, United Kingdom |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25303305$$D View this record in MEDLINE/PubMed |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist. Conceived and designed the experiments: TLF AGK PJH MPFS. Performed the experiments: TLF. Analyzed the data: TLF MPFS. Contributed reagents/materials/analysis tools: TLF. Contributed to the writing of the manuscript: TLF AGK PJH MPFS. |
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References_xml | – volume: 25(5) start-page: 503 year: 2008 ident: ref9 article-title: Postoperative expansion of hemorrhagic contusions after unilateral decompressive hemicraniectomy in severe traumatic brain injury publication-title: Journal of Neurotrauma doi: 10.1089/neu.2007.0442 contributor: fullname: AC Flint – ident: ref3 doi: 10.1007/3-211-30714-1_4 – volume: 153(10) start-page: 2065 year: 2011 ident: ref5 article-title: Decompressive craniectomy is indispensible in the management of severe traumatic brain injury publication-title: Acta Neurochirurgica doi: 10.1007/s00701-011-1101-7 contributor: fullname: R Vashu – volume: 25(3) start-page: 441 year: 2011 ident: ref6 article-title: Decompressive craniectomy for traumatic brain injury: the jury is still out publication-title: British Journal of Neurosurgery doi: 10.3109/02688697.2011.583366 contributor: fullname: PJ Hutchinson – volume: 9 start-page: S287 year: 1992 ident: ref10 article-title: The diagnosis of head injury requires a classification based on computed axial tomography publication-title: Journal of Neurotrauma contributor: fullname: LF Marshall – volume: 154(9) start-page: 1583 year: 2012 ident: ref21 article-title: Increased strain levels and water content in brain tissue after decompressive craniotomy publication-title: Acta Neurochirurgica doi: 10.1007/s00701-012-1393-2 contributor: fullname: H von Holst – volume: 22 start-page: E14 year: 2007 ident: ref1 article-title: Surgery for brain edema publication-title: Neurosurgical Focus doi: 10.3171/foc.2007.22.5.15 contributor: fullname: PJ Hutchinson – volume: 9(7) start-page: 405 year: 2013 ident: ref2 article-title: Decompressive craniectomy: past, present and future publication-title: Nature Reviews Neurology doi: 10.1038/nrneurol.2013.106 contributor: fullname: AG Kolias – volume: 9(7) start-page: 676 year: 2012 ident: ref17 article-title: Fiji: an open-source platform for biological-image analysis publication-title: Nature Methods doi: 10.1038/nmeth.2019 contributor: fullname: J Schindelin – ident: ref20 – ident: ref14 doi: 10.1109/ISBI.2004.1398617 – ident: ref22 doi: 10.3171/foc.1997.2.5.7 – ident: ref4 doi: 10.1002/14651858.CD003983.pub2 – volume: 26(6) start-page: E6 year: 2009 ident: ref12 article-title: A comparison of hinge craniotomy and decompressive craniectomy for the treatment of malignant intracranial hypertension: early clinical and radiographic analysis publication-title: Neurosurgical Focus doi: 10.3171/2009.4.FOCUS0960 contributor: fullname: T Kenning – volume: 26(11) start-page: 1452 year: 2004 ident: ref18 article-title: Statistical region merging publication-title: IEEE Transactions on Pattern Analysis and Machine Intelligence doi: 10.1109/TPAMI.2004.110 contributor: fullname: R Nock – ident: ref19 – ident: ref13 doi: 10.1109/ISBI.2006.1625012 – volume: 123(4) start-page: 239 year: 2011 ident: ref8 article-title: Decompressive craniectomy: technical note publication-title: Acta Neurologica Scandinavica doi: 10.1111/j.1600-0404.2010.01397.x contributor: fullname: T Quinn – volume: 60(7) start-page: 989 year: 2003 ident: ref11 article-title: A longitudinal study of brain volume changes in normal aging using serial registered magnetic resonance imaging publication-title: Archives of Neurology doi: 10.1001/archneur.60.7.989 contributor: fullname: RI Scahill – volume: 16(6) start-page: 22 year: 1999 ident: ref16 article-title: Splines: a perfect fit for signal and image processing publication-title: Signal Processing Magazine, IEEE doi: 10.1109/79.799930 contributor: fullname: M Unser – ident: ref15 – volume: 38 start-page: 115 year: 2012 ident: ref7 article-title: Decompressive craniectomy - operative technique and perioperative care publication-title: Advances and Technical Standards in Neurosurgery doi: 10.1007/978-3-7091-0676-1_6 contributor: fullname: I Timofeev |
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Snippet | Decompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure. However... Background Decompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial... BACKGROUNDDecompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure.... BackgroundDecompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial pressure.... Background Decompressive craniectomy (DC) is a surgical intervention used following traumatic brain injury to prevent or alleviate raised intracranial... |
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SubjectTerms | Analysis Biology and Life Sciences Brain Brain - diagnostic imaging Brain - pathology Brain injuries Brain Injuries - complications Brain Injuries - surgery Brain research Computed tomography Correlation Correlation coefficient Correlation coefficients Decompressive Craniectomy - adverse effects Deformation Diagnosis Displacement Engineering and Technology Head injuries Humans Hypertensive Encephalopathy - diagnosis Hypertensive Encephalopathy - etiology Injury prevention Intervention Intracranial pressure Medical imaging Medicine and Health Sciences Methods Neurosciences Neurosurgery Organ Size Patients Postoperative Period Scholarships & fellowships Skull Statistics Surgery Tomography, X-Ray Computed Traumatic brain injury |
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Title | A new improved method for assessing brain deformation after decompressive craniectomy |
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