Unilateral Frontal-temporal-parietal Acute Subdural Hematoma Lateral Fissure And Lateral Brows Pool Changes And GCS, GOS Relevance

Objective:To analyze the effects of changes in lateral fissure cistern and cornu frontale ventriculi lateralis on the judgment of pathogenetic condition and prognosis in patients who suffered from acute subdural hematoma.Methods:Retrospective analysis of 49 cases on acute subdural hematoma,with general informations,clinical manifestations,imaging datas and prognosis.The statistics datas were screened by patients' conditions,the clinical and imaging datas at the time of most serious disease within 7 days after injury were choose in non-operation patients, while the datas were collected both the most serious conditions at pre-operative and 1 day post surgery in patients who accepted surgical operations after trauma.The hematoma were divided into ipsilateral and contralateral hematoma according to their locations.The compressions of both sides of lateral fissure cistern were recorded and divided into three types:normal,partially compressed and disappeared.The layer in which the compression of cornu frontale ventriculi lateralis were most apparent was choose to anlyze and the lowest layer was level of orbitomeatal line. The conjunction between mid-point of internal occipital protuberance and frontal crest was identified as the middle line.The distance from anterolateral point of ipsilateral cornu frontale ventriculi lateralis to middle line was measured and recorded as A1,while the distance between anterolateral point of contralateral cornu frontale ventriculi lateralis and middle line was recorded as A2.The distance from intersection point of A1,A2 and the middle lane to frontal crest were recorded as B1,B2 respectively.SPSS 17.0 for windows was used for statistical analysis and the associations between above data(A1,A2,B1, B2) and glasgow coma scale(GCS),glasgow outcome scale(GOS) were presumpted.Results:1) 10 cases died in 49 patients(20.4%),two cases of plant survival(4.1%),six cases of severe disability(12.2%),13 patients of moderate disability(26.5%),18 cases of good recovery(36.7%).2) GCS score and ipsilateral lateral fissure cistern changes were significantly correlated(correlation coefficient -0.428,p＜0.01).GCS score and the contralateral lateral fissure cistern changes were significantly correlated(correlation coefficient -0.607,p＜0.01).3) GCS score and A1 were significantly correlated(correlation coefficient 0.472,p＜0.01).GCS score and B1 were significantly correlated (correlation coefficient -0.342,p＜0.05).There was no significant relationship between GCS score and A2,B2.4) In non-surgical group, GOS score and ipsilateral lateral fissure cistern changes were significantly correlated(correlation coefficient -0.458,p＜0.05).GOS score and contralateral lateral fissure cistern changes were significantly correlated(correlation coefficient -0.448,p＜0.05 ).GOS score and A1 were significantly correlated(correlation coefficient 0.475,p＜0.05). There was no significant relationship between GOS score and A2,B1,B2. 5) In surgery group,there was no significant relationship between GOS score and pre-operative changes in bilateral lateral fissure cistern,A1,A2, B1,B2.6) In surgery group,GOS score and postoperative changes in contralateral lateral fissure cistern were significantly correlated (correlation coefficient -0.483,p＜0.05).There was no significant relationship between GOS score and ipsilateral changes in lateral fissure cistern,A1,A2,B1,B2.Conclusion:1) GCS score and the bilateral lateral fissure cistern changes,A1,B1 were significantly related,there was no significant relationship between GCS score and A2,B2.Changes in bilateral lateral fissure cistern,A1,B1 can be used as indicators of pathogenetic condition in patients.2) In non-surgical group,GOS score and changes in bilateral lateral fissure cistern,A1,A2,B1 were significantly related. There was no significant relationship between GOS score and B2. Changes in bilateral lateral fissure cistern,A1 can be used as non-surgical patients predict prognosis.3) In surgery group,GOS score and contralateral lateral fissure cistern changes post surgery were significantly related.To other indicators,including pre-operative changes in bilateral lateral fissure cistern,A1,A2,B1,B2 and post surgery changes in ipsilateral lateral fissure cistern,A1,A2,B1,B2 and GOS score were not significant relationship.Contralateral lateral fissure cistern post surgery can be used as the forecast changes in patients prognosis.