The prognostic value of traumatic brainstem injury on magnetic resonance imaging: A systematic review

Bizhan Aarabi, Aaron Wessell, Nathan Pratt, Timothy Chryssikos, Maureen Scarboro, Cara Diaz Lomangino, Carla Aresco

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations


On October 9, 2017, in an open scientific session of the Congress of Neurological Surgeons on "Neurotrauma and Critical Care," Drs. Shelly Timmons (Pennsylvania State University) and Martina Stippler (Harvard University) presented a lively debate for and against decompressive craniectomy.* * In this session, Dr. Stippler presented the following scenario to the audience: "When the ICP threshold is alarming and life-threatening, who would proceed with decompressive craniectomy for severe traumatic brain injury?" The show of hands overwhelmingly supported decompressive craniectomy. This systematic review appraises the existing body of literature, and focuses specifically on the prognostic value of traumatic brainstem injury (TBSI) on magnetic resonance imaging (MRI) studies in this clinical setting. Does MRI add to the predictive significance of the existing prognostic models? And should it therefore influence decision-making regarding decompressive craniectomy? In the following chapter, we review what has been conclusively written about the role of MRI in predicting neurologic outcome following traumatic injury to the central nervous system and provide a case report of our own. A computerized search of the National Library of Medicine PubMed database of literature, applying multiple medical subject headings, yielded 734 citations addressing MRI and traumatic brain injury. Nine articles specifically reported the prognostic significance of TBSI and long-term outcome. Level II and III evidence indicated that the presence of TBSI on MRI was usually an indication of extensive rostral-caudal traumatic axonal injury and signified unfavorable outcome. In one Level II study, inclusion of MRI variables in the core model (age, pupillary dilatation, and GCS score) of Area Under the Receiver Operating Characteristics (AUROC)+ CT Rotterdam covariates increased the prognostic significance (GOSE =6 at 12 months) from 0.8287 to 0.8763.

Original languageEnglish (US)
Title of host publicationDecompressive Craniectomy
PublisherNova Science Publishers, Inc.
Number of pages24
ISBN (Electronic)9781536131819
ISBN (Print)9781536131802
StatePublished - Jan 1 2018
Externally publishedYes


  • Brainstem
  • Decompressive craniectomy
  • GOSE
  • MRI
  • Outcome
  • TBI

ASJC Scopus subject areas

  • General Medicine
  • General Neuroscience


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