Analysis of influential factors of postoperative secondary hydrocephalus in patients with severe and most severe craniocerebral injury

Abstract

Objective To investigate the risk factors for postoperative secondary hydrocephalus in patients with severe and most severe craniocerebral injury. Methods The clinical data of 144 patients with severe and most severe craniocerebral injury admitted to the Department of Neurosurgery, General Hospital of Ningxia Medical University from June 2010 to December 2013 were analyzed retrospectively. Univariate analysis was used to examine the relationship between the patients’ age, gender, pre/postoperative Glasgow Coma Scale(GCS), site of injury, pre/postoperative intraventricular hematocele, pre/postoperative aqueduct of midbrain and ambient cisterna structure, postoperative large area cerebral infarction, postoperative intracranial infection, postoperative intracranial pressure, as well as the postoperative lumbar puncture and the secondary hydrocephalus, and multivariate logistic analysis was further conducted to investigate the influencing factors of hydrocephalus after procedure. Results The patients with low GCS during the perioperative period(before procedure: P=0.041; after procedure: P=0.039), intraventricular hematocele(before procedure: 0.027; after procedure: 0.039), injury site near skull base(P=0.042), structures of ambient cisterna and aqueduct of midbrain not clear(before procedure: P<0.001; after procedure: P<0.001), postoperative massive cerebral infarction(P=0.031), and postoperative intracranial infection(P=0.027)were the risk factors for secondary hydrocephalus after procedure, and postoperative reduction of intracranial pressure(P=0.001)and early lumbar puncture(P<0.001)were its protective factors. Compared with the patients of the non-lumbar puncture group, postoperative early lumbar puncture could reduce the incidences of acute hydrocephalus(P=0.026)and chronic hydrocephalus(P=0.033)of this kind of craniocerebral injury after the procedure, and there was significant difference in the incidence of hydrocephalus between the patients of both groups. Conclusions The patients with severe and most severe craniocerebral injury who have the low GCS during the perioperative period, preoperative and postoperative intraventricular hematocele, injury site near skull base, structures of the ambient cisterna and aqueduct of midbrain unclear, massive cerebral infarction after procedure, and postoperative intracranial infection are prone to hydrocephalus after procedure. While timely and effectively reducing intracranial pressure and releasing the bloody cerebrospinal fluid after procedure may reduce the occurrence of postoperative hydrocephalus. Key words: Craniocerebral trauma; Hydrocephalus; Neurosurgical procedures; Risk factors