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Decompressive craniectomy and hydrocephalus: proposal of a therapeutic flow chart
Simone Peraio1, Maria Lucia Calcagni2, Maria Vittoria Mattoli2
1Department of Neurosurgery, School of Medicine, Catholic University, Rome, Italy - simoneperaio@virgilio.it.
Insights
Decompressive craniectomy (DC) can cause hydrocephalus and sinking skin-flap syndrome (SSFS). Advanced cerebrospinal fluid (CSF) evaluations aid in managing these complex complications in decompressed patients.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Decompressive craniectomy (DC) is a life-saving procedure for intracranial hypertension.
- Common complications include hydrocephalus and sinking skin-flap syndrome (SSFS).
- Diagnosing and treating these complications in decompressed patients presents challenges.
Purpose of the Study:
- To explore the relationship between hydrocephalus and SSFS after DC.
- To evaluate diagnostic tools for managing ventriculomegaly in decompressed patients.
- To propose a treatment algorithm for these complex cases.
Main Methods:
- Review of clinical and radiological findings in decompressed patients.
- Assessment of cerebrospinal fluid (CSF) dynamics and metabolic evaluations.
- Development of a treatment flowchart based on clinical experience.
Main Results:
- Hydrocephalus and SSFS can be interrelated, with causal links in both directions.
- Standard clinical and radiological assessments may be insufficient for treatment decisions.
- CSF dynamics and metabolic evaluations offer valuable diagnostic insights.
Conclusions:
- Managing hydrocephalus and SSFS post-DC requires careful consideration of their interrelation.
- Advanced CSF evaluations are crucial for guiding therapeutic strategies.
- The proposed flowchart provides a structured approach to treating ventriculomegaly in decompressed patients.
Abstract:
Decompressive craniectomy (DC) may be necessary to save the lives of patients suffering from intracranial hypertension. However, this procedure is not complication-free. Its two main complications are hydrocephalus and the sinking skin-flap syndrome (SSFS). The radiological findings and the clinical evaluation may be not enough to decide when and/or how to treat hydrocephalus in a decompressed patient. SSFS and hydrocephalus may be not unrelated. In fact, a patient affected by hydrocephalus, after the ventriculo-peritoneal shunt, can develop SSFS; on the other hand, SSFS per se can cause hydrocephalus. Treating hydrocephalus in decompressed patients can be challenging. Radiological findings and clinical evaluation may not be enough to define the most appropriate therapeutic strategy. Cerebrospinal fluid (CSF) dynamics and metabolic evaluations can represent important diagnostic tools for assessing the need of a CSF shunt in patients with a poor baseline neurologic status. Based on our experience, we propose a flow chart for treating decompressed patients affected by ventriculomegaly.
