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Factors associated with post traumatic hydrocephalus following decompressive craniectomy: A single-center experience
Damilola Alexander Jesuyajolu1, Terngu Moti1, Abdulahi Ajape Zubair1
1Department of Neurosurgery, Salford Royal Hospital, Salford, Manchester, United Kingdom.
Insights
Cerebellar hematoma and contusions are linked to developing post-traumatic hydrocephalus after decompressive craniectomy for severe traumatic brain injury. This finding aids in predicting shunt-requiring hydrocephalus in these patients.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Neurology
Background:
- Decompressive craniectomy (DC) manages refractory intracranial hypertension in severe traumatic brain injury (sTBI).
- Previous research indicates a link between DC and post-traumatic hydrocephalus (PTH).
- Identifying factors for shunt-amenable PTH post-DC is crucial for patient management.
Purpose of the Study:
- To determine factors associated with developing shunt-amenable post-traumatic hydrocephalus (PTH) in patients who underwent decompressive craniectomy (DC) for severe traumatic brain injury (sTBI).
Main Methods:
- A retrospective review of a prospectively collected database from a tertiary neurosurgical center (January 2012 - May 2022).
- Patients with severe TBI undergoing DC were analyzed.
- Post-traumatic hydrocephalus (PTH) defined by ventricular dilatation, clinical deterioration, or need for CSF diversion (shunt).
Main Results:
- Sixty-five patients were included.
- No significant difference in injury mechanisms between PTH and non-PTH groups.
- Cerebellar hematoma and contusions were significantly associated with developing PTH (P = 0.006).
Conclusions:
- Cerebellar hematoma and contusions are significant predictors of post-traumatic hydrocephalus in patients undergoing decompressive craniectomy.
- These findings help identify patients at higher risk for shunt-requiring hydrocephalus after DC for sTBI.
Background:
A decompressive craniectomy (DC) is a surgical procedure sometimes utilized to manage refractory intracranial hypertension following severe traumatic brain injury (sTBI). The previous studies have established a relationship between DC and post traumatic hydrocephalus (PTH). This study aimed to identify the factors responsible for developing shunt-amenable PTH in patients who underwent DC following sTBI.
Methods:
A review of a prospectively collected database of all patients admitted with severe TBI in a tertiary neurosurgical center in North-west England between January 2012 and May 2022 was performed. PTH was defined as evidence of progressive ventricular dilatation, clinical deterioration, and/or the eventual need for cerebrospinal fluid diversion (i.e., a ventriculoperitoneal shunt). Statistical analysis was carried out using IBM SPSS versus 28.0.1.
Results:
Sixty-five patients met the eligibility criteria and were included in the study. The mean age of the PTH group was 31.38 ± 14.67, while the mean age of the non-PTH group was slightly higher at 39.96 ± 14.85. No statistically significant difference was observed between the two groups' mechanisms of traumatic injury (P = 0.945). Of the predictors investigated, cerebellar hematoma (and contusions) was significantly associated with PTH (P = 0.006).
Conclusion:
This study concludes that cerebellar hematoma (and contusions) are associated with developing PTH in patients undergoing DC.
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