Distance of Hematoma Crossing the Midline as a Predictor of Obstructive Hydrocephalus and Poor Outcome in Patients with Small Amount of Thalamic Hemorrhage

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-07-05 DOI:10.1016/j.wneu.2025.124258

Wanyu Ma , Yue Cheng , Tao Luo , Wenying Zhang , Likun Wang , Guofeng Wu , Siying Ren

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Abstract

Objective

This study aimed to examine the association of distance of hematoma crossing the midline (DHCM) with obstructive hydrocephalus (OH) and 90-day neurological outcomes in patients with small amount of thalamic hemorrhage (SATH).

Methods

A retrospective analysis was conducted in patients with thalamic hemorrhage with a hematoma volume of ≤10 mL. The coronal section of brain computed tomography was used to measure the distance from the hematoma's distal end to the midline, and a cutoff value was determined to predict OH. Binary logistic regression assessed the relationship between this cutoff value and poor outcomes, while a nomogram model and receiver operating characteristic (ROC) curve were generated to evaluate its predictive value for 90-day neurological prognosis.

Results

Among 118 patients with SATH, 23 (19.49%) developed OH. Logistic regression analysis identified DHCM as an independent risk factor for OH (odds ratio: 8.28; 95% confidence interval [CI]: 1.10–62.63). The ROC curve determined a cutoff value of 0.64 cm for DHCM in predicting OH (area under the curve: 0.86; 95% CI: 0.78–0.93). Further logistic regression analysis confirmed that DHCM > 0.64 cm is an independent risk factor for poor outcomes (odds ratio: 13.63; 95% CI: 2.98–62.29). The ROC curve and nomogram model demonstrated that integrating DHCM > 0.64 cm with National Institutes of Health Stroke Scale score and hematoma volume enhanced the predictive accuracy for 90-day neurological prognosis. Additionally, early minimally invasive surgery can reduce the 90 days' mortality of patients with DHCM > 0.64 cm.

Conclusions

In SATH, DHCM > 0.64 cm could serve as a clinically relevant marker for predicting OH and 90-day neurological outcomes.

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血肿越过中线的距离对小量丘脑出血患者梗阻性脑积水和不良预后的预测作用。

目的：本研究旨在探讨血肿跨越中线距离（DHCM）与梗阻性脑积水（OH）及小量丘脑出血（SATH）患者90天神经预后的关系。方法：回顾性分析血肿体积≤10 mL的丘脑出血（TH）患者，采用脑CT冠状面测量血肿远端至中线的距离，确定截断值预测梗阻性脑积水（OH）。二元逻辑回归评估该截断值与不良预后之间的关系，并生成nomogram模型和ROC曲线来评估其对90天神经系统预后的预测价值。结果：118例SATH患者中，23例（19.49%）发生OH。Logistic回归分析发现DHCM是OH的独立危险因素(优势比[OR]: 8.28；95%置信区间[CI]: 1.10-62.63)。ROC曲线确定DHCM预测OH的截断值为0.64 cm(曲线下面积[AUC]: 0.86；95% ci, 0.78-0.93)。进一步的logistic回归分析证实，DHCM >0.64 cm是不良结局的独立危险因素(OR: 13.63；95% ci: 2.98-62.29)。ROC曲线和nomogram model显示DHCM>0.64 cm与NIHSS评分、血肿体积相结合可提高90天神经系统预后的预测准确性。此外，早期微创手术（MIS）可降低DHCM bb0 0.64cm患者90天死亡率。结论：在SATH中，DHCM>0.64 cm可作为预测OH和90天神经预后的临床相关指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS