• Askiel Bruno, Abdurrehman Zahran, Nina Paletta, Laith Maali, Fenwick T Nichols, and Ramon Figueroa.
• Department of Neurology, Medical College of Georgia at Augusta University, Augusta, Georgia. Electronic address: abruno@augusta.edu.
• J. Neurosci. Methods. 2017 Mar 15; 280: 11-15.

BackgroundA standardized, reliable, and practical method for measuring decompressive hemicraniectomy (DHC) defects and brain shifts in malignant middle cerebral artery (MCA) territory infarction is needed for reliable comparisons between computed tomography (CT) scans. Such a method could facilitate further studies on the effects of DHC.New MethodWe describe and apply a method for measuring DHC defects and brain shifts on CT scans in 25 patients with malignant MCA territory infarction. Craniectomy area is adjusted for variations in head size, CT slice orientation is standardized, and the site of each measurement is defined. This method uses standard radiology platforms and volume-acquired helical CT scans.ResultsThe measurements include a DHC size index (adjusted for variations in head size), midline brain shift (subfalcine), outward brain herniation (transcalvarial), and the diameter of the contralateral atrium of the lateral ventricle. Inter-rater agreement for these measurements in a sample of 15 subjects is excellent (correlation coefficients 0.90-0.98).Comparison With Existing MethodsIn contrast to previously reported methods, this method is tested in acute stroke patients, compensates for variability in head size, and includes a midline brain shift (subfalcine) and brain ventricular system measurements.ConclusionsA practical method for measuring DHC size and brain shifts designed to be consistent between scans is proposed. This method should facilitate comparisons of measurements between serial scans, between patients, and perhaps between studies. This method could be useful in medical and surgical studies of brain herniations in malignant MCA territory infarction, and possibly other conditions.Copyright © 2017 Elsevier B.V. All rights reserved.

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