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Risk factors for post-traumatic hydrocephalus following decompressive craniectomy

  • Original Article - Brain trauma
  • Published:
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Abstract

Background

Post-traumatic hydrocephalus (PTH) is one of the main complications of decompressive craniectomy (DC) after traumatic brain injury (TBI). Then, the recognition of risk factors and subsequent prompt diagnosis and treatment of PTH can improve the outcome of these patients. The purpose of this study was to identify factors associated with the development of PTH requiring surgical treatment in patients undergoing DC for TBI.

Methods

In this study, we collected the data of 190 patients (149 males and 41 females), who underwent DC for TBI in our Center. Then we analyzed the type of surgical treatment for all patients affected by PTH and the risk factors associated with the development of PTH.

Results

Post-traumatic hydrocephalus (PTH) developed in 37 patients out of 130 alive 30 days after DC (28.4%). The development of PTH required ventriculoperitoneal shunt (VPS) in 34 patients out of 37 (91.9%), while, in the remaining 3 patients, cerebrospinal fluid hydrodynamic (CSF) disturbances resolved after urgent cranioplasty and temporary external lumbar drain. Multivariate analysis showed that the presence of interhemispheric hygroma (p < 0.001) and delayed cranioplasty (3 months after DC) (p < 0.001) was significantly associated with the need for a VPS or other surgical procedure for PTH. Finally, among the 130 patients alive after 30 days from DC, PTH was associated with unfavorable outcome as measured by the 6-month Glasgow Outcome Scale score (p < 0.0001).

Conclusions

Our results showed that delayed cranial reconstruction was associated with an increasing rate of PTH after DC. The presence of an interhemispheric hygroma was an independent predictive radiological sign of PTH in decompressed patients for severe TBI.

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Authors and Affiliations

  1. Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, 60020, Ancona, Italy

    Davide Nasi, Maurizio Gladi, Alessandro Di Rienzo, Lucia di Somma, Elisa Moriconi, Maurizio Iacoangeli & Mauro Dobran

Authors
  1. Davide Nasi
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  2. Maurizio Gladi
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  3. Alessandro Di Rienzo
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  4. Lucia di Somma
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  5. Elisa Moriconi
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  6. Maurizio Iacoangeli
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  7. Mauro Dobran
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Corresponding author

Correspondence to Davide Nasi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Comments

In this retrospective observational study, Dr. Nasi et al. investigate the incidence rate of hydrocephalus following decompressive craniectomy (DC) for traumatic brain injury (TBI). In their patient cohort of 130 patients surviving the first month after DC, 37 patients (28%) were diagnosed with hydrocephalus defined by both progressive ventricular enlargement and clinical deterioration. The presence of an interhemispheric hygroma during the early phase after DC and cranioplasty later than 3 months after DC was independent risk factors for the development of symptomatic hydrocephalus requiring treatment. Interhemispheric hygroma may indeed be an indicator of disturbed cerebrospinal fluid circulation (caused by the trauma or the large skull defect resulting from the DC) and this radiological finding should be taken into account in evaluation of patients with clinical deterioration following DC, when hydrocephalus is suspected. The effect of cranioplasty timing is still debated and controversial. A recent (and larger) observational study by Morton et al. came to the opposite conclusion that cranioplasty later that 90 days after DC was associated with a lower risk of hydrocephalus. [1] This issue needs further exploration in future prospective (randomized?) studies.

Alexander Lilja-Cyron

Copenhagen, Denmark

1. Morton RP, Abecassis IJ, Hanson JF, et al (2017) Timing of cranioplasty: a 10.75-year single-center analysis of 754 patients. J Neurosurg 128(128):1-5

This article is part of the Topical Collection on Brain trauma

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Nasi, D., Gladi, M., Di Rienzo, A. et al. Risk factors for post-traumatic hydrocephalus following decompressive craniectomy. Acta Neurochir 160, 1691–1698 (2018). https://doi.org/10.1007/s00701-018-3639-0

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  • DOI: https://doi.org/10.1007/s00701-018-3639-0

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