Post Traumatic Hydrocephalus in Indian Subpopulation: An Institutional Experience.

Abstract

To identify subgroups of cases with ventriculomegaly who will benefit from the cerebrospinal fluid (CSF) diversion procedures, n patients with post-traumatic hydrocephalus (PTH), and to identify the risk factors for its development to minimize its occurrence. We analyzed 500 head injury cases who were admitted over a one and a half year period in our institute with PTH, to assess them for treatment benefit by CSF diversion procedures and associated risk factors for its development. The patients were assigned to one of three groups: Group 1 had ventriculomegaly with periventricular lucency (PVL), and raised intracranial pressure (ICP) 2.1% (10/500). Group 2 had ventriculomegaly with PVL, and normal opening pressure 1.75% (7/500) and Group three had no ventriculomegaly 95.75% (483/500). The incidence of radiological PTH in this study was 3.4% (17/500), and it developed after an average interval of 16.43 ± 23.7 (SD) in Group 1 and 19.76 ± 8.9 (SD) weeks in Group 2. Lower Glasgow Coma Score (GCS) (p < 0.001), decompressive craniotomy (p < 0.001) and requirement for prolonged ventilatory support (p < 0.001) were significantly associated with the development of PTH. Significantly better results were found in cases with PTH and high opening CSF pressure (? 15 mmHg) on Lumbar puncture (p < 0.001). Decompressive craniotomy cases required significantly more shunt revisions compared to conservatively managed cases (p < 0.05). CSF diversion procedures help to improve ventriculomegaly cases with documented evidence of raised ICP but not in cases without raised ICP. The subgroup of PTH, which cannot be treated by CSF diversion procedures, can only be managed by minimizing many of the risk factors for its development. In cases with severe head injury, a low GCS, and prolonged ICU stay, decompressive craniotomy should be used judiciously. The duration of mechanical ventilation should be minimized and combined with necessary measures to improve GCS.