Progress in the diagnosis and treatment of post-traumatic hydrocephalus

Post-traumatic hydrocephalus (PTH) is a frequent secondary complication after traumatic brain injury and significantly affects neurological recovery and prognosis. This review summarizes epidemiology, mechanisms, risk factors, diagnostic advances, and treatment strategies to improve clinical recognition and management.

A narrative literature review was conducted using major medical databases to identify clinical, imaging, and experimental studies addressing incidence, pathophysiology, diagnosis, and therapy of PTH. Relevant findings were synthesized qualitatively.

PTH occurs across injury severities and is associated with subarachnoid hemorrhage, decompressive craniectomy, infection, and advanced age. Proposed mechanisms include cerebrospinal fluid circulation disturbance, impaired absorption, neuroinflammation, and altered intracranial compliance. Diagnostic accuracy has improved with advanced neuroimaging and dynamic cerebrospinal fluid assessment. Therapeutic approaches have evolved from conventional shunting to individualized strategies incorporating endoscopic techniques and adjustable shunt systems.

PTH remains underdiagnosed due to heterogeneous presentations. Future efforts should focus on standardized diagnostic criteria and early risk stratification, integration of glymphatic and aquaporin-4 (AQP4) pathways, biomarker- and AI-guided diagnostics, and mechanism-targeted preventive strategies across the acute, subacute, and chronic phases of PTH.