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

Abstract

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