Predicting the progression of chronic subdural hematoma based on skull density

Weijian Yang; Qifang Chen; Haijun Yao; Jun Zhang; Quan Zhang; Jiang Fang; Gang Wu; Jin Hu

doi:10.3389/fneur.2023.1279292

Predicting the progression of chronic subdural hematoma based on skull density

Front Neurol. 2023 Oct 20:14:1279292. doi: 10.3389/fneur.2023.1279292. eCollection 2023.

Authors

Weijian Yang^{1

2

3

4

5}, Qifang Chen^{1

2

3

4

6}, Haijun Yao^{1

2

3

4

7}, Jun Zhang^{1

2

3

4

5}, Quan Zhang^{1

2

3

4

5}, Jiang Fang^{1

2

3

4

5}, Gang Wu^{1

2

3

4

5}, Jin Hu^{1

2

3

4

5}

Affiliations

¹ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
² National Center for Neurological Disorders, Shanghai, China.
³ Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.
⁴ Neurosurgical Institute of Fudan University, Shanghai, China.
⁵ Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.
⁶ Department of Nursing, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
⁷ Department of Neurosurgery and Neurocritical Care, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.

Abstract

Objective: The objective of this study was to investigate potential correlations between skull density and the progression of chronic subdural hematoma (CSDH).

Methods: Patients with unilateral CSDH were retrospectively enrolled between January 2018 and December 2022. Demographic and clinical characteristics, as well as hematoma and skull density (Hounsfield unit, Hu), were collected and analyzed.

Results: The study enrolled 830 patients with unilateral CSDH until the resolution of the CDSH or progressed with surgical treatment. Of the total, 488 patients (58.80%) necessitated surgical treatment. The study identified a significant correlation between the progression of CSDH and three variables: minimum skull density (MiSD), maximum skull density (MaSD), and skull density difference (SDD) (p < 0.001). Additionally, in the multivariable regression analysis, MiSD, MaSD, and SDD were independent predictors of CSDH progression. The MiSD + SDD model exhibited an accuracy of 0.88, as determined by the area under the receiver operating characteristic curve, with a sensitivity of 0.77 and specificity of 0.88. The model's accuracy was validated through additional analysis.

Conclusion: The findings suggest a significant correlation between skull density and the CSDH progression.

Keywords: chronic subdural hematoma; midline shift; progression; skull density; surgery.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was funded by Research foundation of Huashan Hospital affiliated to Fudan University (2021QD026), Shanghai Shenkang Hospital Development Center promoted and optimized management of diagnosis and treatment technology in municipal hospitals (SHDC22022210 and SHDC22022210) and Hainan Academician Innovation Platform Fund (YSPTZX202033).