Clinical diagnosis and treatment of traumatic brain injury complicated with hydrocephalus after decompressive craniectomy

Abstract

Objective To summarize the risk factors and treatment of hydrocephalus after traumatic craniocerebral trauma. Methods A single center retrospective cohort study of 196 surviving patients with traumatic craniocerebral trauma after traumatic craniocerebral trauma from July 2012 to December 2016 in Department of Neurosurgery, Ji’nan Military General Hospital, was divided into 2 groups according to the skull CT or MRI images within 5-15 d after operation: longitudinal fissure effusion or/and subdural subdural. The effusion was A group (81 cases), and no longitudinal fissure effusion or/or subdural effusion was B group (115 cases). Continuous lumbar external cistern drainage and ventriculoperitoneal shunt were used to treat patients with longitudinal fissure effusion and/or subdural effusion in group A. Results CT or MRI were followed up for 6 months. Fifty seven of the 81 patients in group A had hydrocephalus, the incidence was 70%. Only 10 of the 115 patients in group B had hydrocephalus, and the incidence was 8.7%. The incidence of hydrocephalus in the 2 groups was statistically significant (χ2=80.35, P<0.05). Patients in group A were given 5-10 d lumbar cistern continuous external drainage, 24 patients had no symptoms of hydrocephalus after operation, and the effective rate was 49%. Group B was followed up with hydrocephalus in 10 cases within 6 months, and 4-7 d was continuously drained in the lumbar cistern, and 10 cases of hydrocephalus were relapsed after pulling out the drainage tube. Two groups of A and B were treated with ventriculoperitoneal shunt (VPS), hydrocephalus imaging and patients’clinical symptoms (GCS score increased) in 62 cases, with an effective rate of 92.5%. Conclusion The occurrence of longitudinal hydrops and/or subdural effusion after craniocerebral trauma is one of the causes of hydrocephalus. Once there is longitudinal fissure effusion and/or subdural effusion, follow up CT follow-up should be followed, positive symptomatic treatment should be given and clinical symptoms should be improved. Key words: Decompressive craniectomy; Longitudinal fissure effusion; Subdural effusion; Hydrocephalus