J Neurol Surg A Cent Eur Neurosurg 2016; 77(02): 088-092
DOI: 10.1055/s-0035-1558411
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Posttraumatic Hydrocephalus after Decompressive Craniectomy in 126 Patients with Severe Traumatic Brain Injury

George Fotakopoulos
1   Department of Neurosurgery, University Hospital of Thesaly, Larissa, Thesaly, Greece
,
Eleni Tsianaka
1   Department of Neurosurgery, University Hospital of Thesaly, Larissa, Thesaly, Greece
,
Giannis Siasios
1   Department of Neurosurgery, University Hospital of Thesaly, Larissa, Thesaly, Greece
,
Konstantinos Vagkopoulos
1   Department of Neurosurgery, University Hospital of Thesaly, Larissa, Thesaly, Greece
,
Kostas Fountas
1   Department of Neurosurgery, University Hospital of Thesaly, Larissa, Thesaly, Greece
› Author Affiliations
Further Information

Publication History

02 September 2014

10 March 2015

Publication Date:
09 September 2015 (online)

Abstract

Objective Severe traumatic brain injuries (TBIs) occur frequently. In some of these patients decompressive craniectomy (DC) must be performed. Posttraumatic hydrocephalus (PTH) can develop after TBI further damaging the brain. DC is considered to be one of the causes of PTH. This study defines the incidence of PTH in TBI patients who underwent DC and tries to determine associated factors.

Materials and Methods We conducted a retrospective study (2009–2013) that included 126 patients with severe TBI and DC. The collected data were demographics, the craniectomy size, the presence or absence of hydrocephalus, the need for changing the opening pressure of the valve of the cerebrospinal fluid (CSF) shunt or replacing all or parts of the CSF shunt, and the interval between cranioplasty and shunt placement. We excluded patients with additional intraventricular hemorrhage and those with bilateral or bifrontal DC.

Results Ten of the 126 patients (7.9%) developed PTH and were treated with a CSF shunt. There was no statistical correlation between development of PTH and age or sex, but a statistically significant correlation between development of PTH and the size of DC.

Conclusion Our study suggests that PTH development is multifactorial and shows that PTH is not that rare. We showed a correlation between craniectomy size and the incidence of PTH.

 
  • References

  • 1 Faul M, Xu L, Wald MM , et al. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010 http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf . Accessed December 8, 2013
  • 2 Le TH, Gean AD. Imaging of head trauma. Semin Roentgenol 2006; 41 (3) 177-189
  • 3 Pangilinan II PH, Kelly BM, Hornyak JE , et al. Posttraumatic hydrocephalus. Available at: http://emedicine.medscape.com/article/326411-overview
  • 4 Snell RS. Clinical Neuroanatomy [Greek edition; Papadopoulos N, ed.]. Athens, Greece: Litsas; 2008: 450-459
  • 5 Dandy W, Blackfan KD. Internal hydrocephalus. An experimental, clinical and pathological study. Am J Dis Child 1914; 8: 406-482
  • 6 Choi I, Park HK, Chang JC, Cho SJ, Choi SK, Byun BJ. Clinical factors for the development of posttraumatic hydrocephalus after decompressive craniectomy. J Korean Neurosurg Soc 2008; 43 (5) 227-231
  • 7 Ban SP, Son YJ, Yang HJ, Chung YS, Lee SH, Han DH. Analysis of complications following decompressive craniectomy for traumatic brain injury. J Korean Neurosurg Soc 2010; 48 (3) 244-250
  • 8 Bowers CA, Riva-Cambrin J, Hertzler II DA, Walker ML. Risk factors and rates of bone flap resorption in pediatric patients after decompressive craniectomy for traumatic brain injury. J Neurosurg Pediatr 2013; 11 (5) 526-532
  • 9 Takeuchi S, Nawashiro H, Otani N, Shima K. Post-traumatic hydrocephalus following decompressive craniectomy. J Neurotrauma 2012; 29 (5) 1028
  • 10 De Bonis P, Pompucci A, Mangiola A, Rigante L, Anile C. Post-traumatic hydrocephalus after decompressive craniectomy: an underestimated risk factor. J Neurotrauma 2010; 27 (11) 1965-1970
  • 11 Kan P, Amini A, Hansen K , et al. Outcomes after decompressive craniectomy for severe traumatic brain injury in children. J Neurosurg 2006; 105 (5, Suppl): 337-342
  • 12 Gudeman SK, Kishore PR, Becker DP , et al. Computed tomography in the evaluation of incidence and significance of post-traumatic hydrocephalus. Radiology 1981; 141 (2) 397-402
  • 13 Chibbaro S, Tacconi L. Role of decompressive craniectomy in the management of severe head injury with refractory cerebral edema and intractable intracranial pressure. Our experience with 48 cases. Surg Neurol 2007; 68 (6) 632-638
  • 14 Huang AP, Tu YK, Tsai YH , et al. Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion. J Neurotrauma 2008; 25 (11) 1347-1354
  • 15 Yang XF, Wen L, Shen F , et al. Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien) 2008; 150 (12) 1241-1247 ; discussion 1248
  • 16 Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 2006; 104 (4) 469-479
  • 17 Honeybul S. Complications of decompressive craniectomy for head injury. J Clin Neurosci 2010; 17 (4) 430-435
  • 18 Gaab MR, Rittierodt M, Lorenz M, Heissler HE. Traumatic brain swelling and operative decompression: a prospective investigation. Acta Neurochir Suppl (Wien) 1990; 51: 326-328
  • 19 Guerra WK, Gaab MR, Dietz H, Mueller JU, Piek J, Fritsch MJ. Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 1999; 90 (2) 187-196
  • 20 Honeybul S, Ho KM. Long-term complications of decompressive craniectomy for head injury. J Neurotrauma 2011; 28 (6) 929-935
  • 21 Shi SS, Zhang GL, Zeng T, Lin YF. Posttraumatic hydrocephalus associated with decompressive cranial defect in severe brain-injured patients. Chin J Traumatol 2011; 14 (6) 343-347
  • 22 Honeybul S, Ho KM. Incidence and risk factors for post-traumatic hydrocephalus following decompressive craniectomy for intractable intracranial hypertension and evacuation of mass lesions. J Neurotrauma 2012; 29 (10) 1872-1878
  • 23 Kaen A, Jimenez-Roldan L, Alday R , et al. Interhemispheric hygroma after decompressive craniectomy: does it predict posttraumatic hydrocephalus?. J Neurosurg 2010; 113 (6) 1287-1293
  • 24 Polin RS, Shaffrey ME, Bogaev CA , et al. Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 1997; 41 (1) 84-92 ; discussion 92–94
  • 25 Yang XJ, Hong GL, Su SB, Yang SY. Complications induced by decompressive craniectomies after traumatic brain injury. Chin J Traumatol 2003; 6 (2) 99-103
  • 26 Cho BR, Lee HJ, Lee HJ , et al. Risk factors for the post-traumatic hydrocephalus following decompressive craniectomy in severe traumatic injury patients. Korean J Neurotrauma 2012; 8: 110-114
  • 27 De Bonis P, Sturiale CL, Anile C , et al. Decompressive craniectomy, interhemispheric hygroma and hydrocephalus: a timeline of events?. Clin Neurol Neurosurg 2013; 115 (8) 1308-1312
  • 28 Wen L, Wan S, Zhan RY , et al. Shunt implantation in a special sub-group of post-traumatic hydrocephalus—patients have normal intracranial pressure without clinical representations of hydrocephalus. Brain Inj 2009; 23 (1) 61-64
  • 29 Su TM, Lee TH, Huang YH, Su FW, Chen WF. Contralateral subdural effusion after decompressive craniectomy in patients with severe traumatic brain injury: clinical features and outcome. J Trauma 2011; 71 (4) 833-837
  • 30 Oi S, Matsumoto S. Post-traumatic hydrocephalus in children: pathophysiology and classification. Annu Rev Hydrocephalus 1990; xx: 147-148
  • 31 Hawkins TD, Lloyd AD, Fletcher GI, Hanka R. Ventricular size following head injury: a clinico-radiological study. Clin Radiol 1976; 27 (3) 279-289
  • 32 Levin HS, Meyers CA, Grossman RG, Sarwar M. Ventricular enlargement after closed head injury. Arch Neurol 1981; 38 (10) 623-629
  • 33 Jiao QF, Liu Z, Li S , et al. Influencing factors for posttraumatic hydrocephalus in patients suffering from severe traumatic brain injuries. Chin J Traumatol 2007; 10 (3) 159-162
  • 34 Tian HL, Xu T, Hu J, Cui YH, Chen H, Zhou LF. Risk factors related to hydrocephalus after traumatic subarachnoid hemorrhage. Surg Neurol 2008; 69 (3) 241-246 ; discussion 246
  • 35 Jeon SW, Choi JH, Jang TW, Moon SM, Hwang HS, Jeong JH. Risk factors associated with subdural hygroma after decompressive craniectomy in patients with traumatic brain injury : a comparative study. J Korean Neurosurg Soc 2011; 49 (6) 355-358
  • 36 Mazzini L, Campini R, Angelino E, Rognone F, Pastore I, Oliveri G. Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome. Arch Phys Med Rehabil 2003; 84 (11) 1637-1641
  • 37 Takeuchi S, Nagatani K, Wada K , et al. Is decompressive craniectomy a risk factor for ventriculomegaly?. Acta Neurochir Suppl (Wien) 2013; 118: 281-283
  • 38 Iencean TM, Ianovici N, Ciurea AV. Intracranial pressure monitoring study in severe traumatic brain injury and post-traumatic hydrocephalus. Romanian Neurosurg 2009; 16 (2) 17
  • 39 Waziri A, Fusco D, Mayer SA, McKhann II GM, Connolly Jr ES. Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke. Neurosurgery 2007; 61 (3) 489-493 ; discussion 493–494
  • 40 Sarkari A, Gupta DK, Sinha S, Kale SS, Mahapatra AK. Post-traumatic hydrocephalus: presentation, management and outcome—an apex trauma center experience. Indian J Neurotrauma 2010; 7 (2) 135-138
  • 41 Foroglou G, Zander E. Post-traumatic hydrocephalus and measurement of cerebrospinal fluid pressure [in French]. Acta Radiol Diagn (Stockh) 1972; 13 (0) 524-530
  • 42 Guyot LL, Michael DB. Post-traumatic hydrocephalus. Neurol Res 2000; 22 (1) 25-28
  • 43 Beyerl B, Black PM. Posttraumatic hydrocephalus. Neurosurgery 1984; 15 (2) 257-261
  • 44 Tribl G, Oder W. Outcome after shunt implantation in severe head injury with post-traumatic hydrocephalus. Brain Inj 2000; 14 (4) 345-354
  • 45 Cardoso ER, Galbraith S. Posttraumatic hydrocephalus—a retrospective review. Surg Neurol 1985; 23 (3) 261-264
  • 46 Osuka S, Matsushita A, Yamamoto T , et al. Evaluation of ventriculomegaly using diffusion tensor imaging: correlations with chronic hydrocephalus and atrophy. J Neurosurg 2010; 112 (4) 832-839