Korean J Neurotrauma.  2012 Oct;8(2):110-114. 10.13004/kjnt.2012.8.2.110.

Risk Factors for the Post-Traumatic Hydrocephalus Following Decompressive Craniectomy in Severe Traumatic Injury Patients

• Cho BR
• Lee HJ
• Lee HJ
• Yi JS
• Yang JH
• Lee IW

• KMID: 1427722
• DOI: http://doi.org/10.13004/kjnt.2012.8.2.110

Abstract

OBJECTIVE
The goal of this study was to assess the incidence and risk factors for post-traumatic hydrocephalus (PTH) following decompressive craniectomy (DC). An additional objective was to investigate the relationship between hydrocephalus and subdural hygroma (SDG) after DC.
METHODS
We conducted a retrospective study of 94 patients who were admitted to our department between 2007 and 2010 with severe head injury requiring DC. Post-traumatic hydrocephalus was defined as: frontal horn index (FHI) > or =0.4 or modified FHI > or =0.33 accompanying transependymal edema; the presence of either clinical worsening or failure to make neurological improvement over time; and clinical improvement after ventriculoperitoneal shunt. Post-traumatic SDG was defined as the presence of low density at computerized tomography (CT) of more than 5mm thickness.
RESULTS
Among the 94 patients, we could follow up more than 3 months and obtain more than 4 serial CT scans in 41 patients. PTH developed in 29.3% (12/41) and SDG developed in 48.8% (20/41) of these patients. The development of PTH was significantly associated with delayed craniplasty after DC and with interhemispheric SDG. No relationship was found between PTH and age, sex, Glasgow Coma Scale (GCS) score, intraventricular hemorrhage, subarachnoid hemorrhage, midline shift, basal cistern effacement, or cortical opening during DC.
CONCLUSION
Hydrocephalus occurred in 29.3% of the patients with severe traumatic brain injury who required DC. Delayed cranioplasty and interhemispheric SDG after DC were risk factors for the development of PTH.

Keyword

Decompressive craniectomy; Hydrocephalus; Subdural hygroma

MeSH Terms

Animals
Brain Injuries
Craniocerebral Trauma
Decompressive Craniectomy
Follow-Up Studies
Glasgow Coma Scale
Hemorrhage
Horns
Humans
Hydrocephalus
Incidence
Retrospective Studies
Risk Factors
Subarachnoid Hemorrhage
Subdural Effusion
Ventriculoperitoneal Shunt

Figure

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  FIGURE 1. Computerized tomography (CT) findings of a patient with severe traumatic injury. A: Initial CT showing multiple contusion and midline shift; the patient's initial Glasgow Coma Scale score was 9. B: CT was performed at 6 days after decompressive craniectomy. C: CT at 28 days after decompressive craniectomy showing interhemispheric subdural hygroma. D: Patient needed ventriculoperitoneal shunt due to hydrocephalus.

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