Temporal Horn Enlargements Predict Secondary Hydrocephalus Diagnosis Earlier than Evans’ Index
Paolo Missori,
Sergio Paolini,
Simone Peschillo,
Cristina Mancarella,
Anthony Kevin Scafa,
Emanuela Rastelli,
Stefano Martini,
Francesco Fattapposta,
Antonio Currà
Affiliations
Paolo Missori
Department of Human Neurosciences, Neurosurgery, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy
Sergio Paolini
IRCCS Neuromed-Pozzilli, “Sapienza” University of Rome, 86077 Pozzilli, Italy
Simone Peschillo
Department of Neurosurgery, University of Catania, 95124 Catania, Italy
Cristina Mancarella
IRCCS Neuromed-Pozzilli, “Sapienza” University of Rome, 86077 Pozzilli, Italy
Anthony Kevin Scafa
Department of Human Neurosciences, Neurosurgery, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy
Emanuela Rastelli
Department of Radiology, Neuroradiology, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy
Stefano Martini
Department of Radiology, Neuroradiology, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy
Francesco Fattapposta
Department of Human Neurosciences, Neurology, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy
Antonio Currà
Academic Neurology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Ospedale A. Fiorini, “Sapienza” University of Rome, 04019 Terracina, Italy
The aim of this study was to identify early radiological signs of secondary hydrocephalus. We retrieved neuroradiological data from scans performed at various times in patients who underwent surgery for secondary hydrocephalus due to severe traumatic brain injury (TBI), subarachnoid haemorrhage (SAH), or brain tumour (BT). Baseline measurements, performed on the earliest images acquired after the neurological event (T0), included Evans’ index, the distance between frontal horns, and the widths of both temporal horns. The next neuroimage that showed an increase in at least one of these four parameters—and that lead the surgeon to act—was selected as an indication of ventricular enlargement (T1). Comparisons of T0 and T1 neuroimages showed increases in Evans’ index, in the mean frontal horn distance, and in the mean right and left temporal horn widths. Interestingly, in T1 scans, mean Evans’ index scores > 0.30 were only observed in patients with BT. However, the temporal horn widths increased up to ten-fold in most patients, independent of Evans’ index scores. In conclusion temporal horn enlargements were the earliest, most sensitive findings in predicting ventricular enlargement secondary to TBI, SAH, or BT. To anticipate a secondary hydrocephalus radiological diagnosis, clinicians should measure both Evans’ index and the temporal horn widths, to avoid severe disability and poor outcome related to temporal lobe damage.
