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Indian Journal of Neurotrauma 2013; 10(02): 86-91
DOI: 10.1016/j.ijnt.2013.10.005
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Theco-peritoneal shunt for post-traumatic hydrocephalus – A valuable adjunct?

Manoj Phalak
a   Senior Resident, Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India
,
Deepak Agrawal
b   Associate Professor, Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India
,
Pankaj Dawar
a   Senior Resident, Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India
,
Anil Kumar Kothiwala
c   Junior Resident, Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India
,
Pankaj K. Singh
d   Assistant Professor, Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India
,
Bhawani Shankar Sharma
e   Professor and Head, Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India
› Author Affiliations
Subject Editor:
Further Information

Publication History

17 February 2013

23 October 2013

Publication Date:
06 April 2017 (online)

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Abstract

Introduction

Majority of patients undergoing decompressive craniectomy (DC) for traumatic brain injury may develop post-traumatic hydrocephalus (PTH). This remains a challenge to manage as most patients are tracheotomised and run high risk of shunt infection and malfunction following VP shunt. Theco-peritoneal shunt (TP shunt) may be an attractive alternative in this scenario.

Aims & objectives

To assess the role of TP shunt in PTH with respect to the patient population, complications & clinical outcome in TBI.

Materials & methods

In this retrospective study over 32 months (September 2009–April 2012) records of all patients of TBI who underwent TP shunt at a level 1 trauma centre were analysed. Clinical, radiological and follow up data were reviewed in all cases.

Observations & results

A total of 22 TP shunts were done in the study period. Of these 77.2% patients had severe head injury, 18.2% had moderate head injury and 4.5% had mild head injury. The most common initial CT findings were acute SDH in 86.4% and contusions in 81.8% of the patients. 95.5% patients underwent DC at initial admission. Most common presentations of PTH were bulging flap (95.5%), vomiting (72.7%) and headache (63.3%).

91.9% of the patient had tracheostomy in situ. Of these, 5 patients (25%) had positive tracheal cultures and six (27.3%) patients had scalp bedsore/flap infection prior to TP shunt. Following TP shunt, 77.3% patients showed clinical &/or radiological improvement. Shunt infection and revision rates were 0% and 22.7% respectively.

Conclusions

PTH in patients with TBI needs a holistic approach in view of scalp bed sores, tracheostomy and altered ventricular anatomy. TP shunt is a safe, minimally morbid procedure which should be considered as an attractive alternative to VP shunt in patients with PTH.

Keywords

Traumatic brain injury - Post-traumatic hydrocephalus - Theco peritoneal shunt - Ventriculo peritoneal shunt
 

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