A Spherical Cap Model of Epidural Hematomas

Heng-Chun Liao; Cheng-Loong Liang; Chien-Hua Chen; Chun-Chih Liao; Furen Xiao

doi:10.7759/cureus.53653

A Spherical Cap Model of Epidural Hematomas

Cureus. 2024 Feb 5;16(2):e53653. doi: 10.7759/cureus.53653. eCollection 2024 Feb.

Authors

Heng-Chun Liao¹, Cheng-Loong Liang², Chien-Hua Chen³, Chun-Chih Liao⁴, Furen Xiao^{5

6}

Affiliations

¹ Department of Medical Imaging, National Taiwan University Hospital, Taipei, TWN.
² Department of Neurosurgery, E-DA Hospital, Kaohsiung, TWN.
³ Biomedical Engineering, National Taiwan University, Taipei, TWN.
⁴ Department of Neurosurgery, Taipei Hospital, Taipei, TWN.
⁵ Medical Device and Imaging, National Taiwan University, Taipei, TWN.
⁶ Department of Neurosurgery, National Taiwan University Hospital, Taipei, TWN.

Abstract

Background Epidural hematomas (EDHs), which have a characteristic biconvex shape, are a type of post-traumatic intracranial mass. EDHs and other types of intracranial hematomas are often diagnosed with computed tomography (CT). The volumes of EDHs are important in treatment decisions and prognosis. Their volumes are usually estimated on CT using the "ABC" method, which is based on the ellipsoid shape rather than their biconvex shape. Objective To simulate the biconvex shape, we modeled the geometry of EDHs with two spherical caps. We aim to provide simpler estimation of EDH volumes in clinical settings, and eventually recommend a threshold for surgical evacuation. Methods Applying the relationship between the sphere radius, spherical cap height, and base circle radius, we derived formulas for the shape of an EDH, relating its largest diameter and location to the other two diameters. We also estimated EDH volumes using the spherical cap volume and conventional ABC formulas and then constructed a lookup table accordingly. Results Validation of the model was performed using 14 CT image sets from previously reported patients with EDHs. Our geometric model demonstrated accurate predictions. The model also allows reducing the number of parameters to be measured in the ABC method from three to one, the hematoma length, showcasing its potential as a reliable tool for clinical decision-making. Based on our model, an EDH longer than 7 cm would occupy more than 30 mL of the intracranial volume. Conclusion The proposed model offers a streamlined approach to estimating EDH volumes, reducing the complexity of parameters required for clinical assessments. We recommend a length of 7 cm as a threshold for surgical evacuation of EDHs. This acceleration in decision-making is crucial for managing critically injured patients with traumatic brain injuries. Further validation across diverse patient populations will enhance the generalizability and utility of this geometric modeling approach in clinical settings.

Keywords: abc method; computed tomography (ct ); epidural hematoma; spherical cap; volumetry.

Grants and funding

This research was funded by National Taiwan University Hospital/E-DA Hospital grant number 110-EDN03 and Taiwan National Science and Technology Council grant number 111-2221-E-002-049-MY3.