Abstract
The development of hydrocephalus after severe traumatic brain injury (TBI) is an under-recognized healthcare phenomenon and can increase morbidity. The current study aims to characterize post-traumatic hydrocephalus (PTH) in a large cohort. Patients were prospectively enrolled age 16–80 years old with Glasgow Coma Scale (GCS) score 8. Demographics, GCS, Injury Severity Score (ISS), surgery, and cerebrospinal fluid (CSF) were analyzed. Outcomes were shunt failure and Glasgow Outcome Scale (GOS) at 6 and 12-months. Statistical significance was assessed at p < 0.05. In 402 patients, mean age was 38.0 ± 16.7 years and 315 (78.4%) were male. Forty (10.0%) patients developed PTH, with predominant injuries being subdural hemorrhage (36.4%) and diffuse axonal injury (36.4%). Decompressive hemicraniectomy (DHC) was associated with hydrocephalus (OR 3.62, 95% CI (1.62–8.07), p < 0.01). Eighteen (4.5%) patients had shunt failure and proximal obstruction was most common. Differences in baseline CSF cell count were associated with increased shunt failure. PTH was not associated with worse outcomes at 6 (p = 0.55) or 12 (p = 0.47) months. Hydrocephalus is a frequent sequela in 10.0% of patients, particularly after DHC. Shunt placement and revision procedures are common after severe TBI, within the first 4 months of injury and necessitates early recognition by the clinician.
Highlights
Post-traumatic hydrocephalus (PTH) is a serious but treatable sequelae of traumatic brain injury (TBI), with reports of its incidence ranging from 8% to 36% [1,2,3,4]
Prior findings in patient cohorts who underwent decompressive hemicraniectomy showed that younger age and the presence of interhemispheric hygroma were associated with PTH [1]
From May 2000 to July 2014, a total of 402 patients with severe blunt TBI were enrolled in the prospective study (Figure 1)
Summary
Post-traumatic hydrocephalus (PTH) is a serious but treatable sequelae of traumatic brain injury (TBI), with reports of its incidence ranging from 8% to 36% [1,2,3,4]. Hydrocephalus is frequently described in patients who underwent decompressive hemicraniectomy (DHC) [5,6], it is a complication in patients who did not undergo decompressive craniectomy for which additional relevant research is needed. Prior findings in patient cohorts who underwent decompressive hemicraniectomy showed that younger age and the presence of interhemispheric hygroma were associated with PTH [1]. The development of hydrocephalus in the severe TBI population is further evaluated in the current study utilizing a longitudinal prospective cohort of patients with severe TBI managed at our institution. The measurable benefits of CSF diversion have been shown in 11–52% of patients on behavioral and functional tests [12,13]. Shunt malfunction and complications arising from shunting procedures are well-known neurosurgical challenges that require repeated hospitalizations and revision operations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
