Relationship Between Decompressive Craniectomy and Hydrocephalus

Abstract

To the Editor: We read with great interest the article by Rahme et al1 in which the authors reviewed the records of 17 patients with stroke-related increased intracranial pressure who underwent decompressive craniectomy (DC). The authors described a 0% rate of shunting after DC and concluded that hydrocephalus does not frequently occur after DC. On the other hand, in the series of Waziri et al,2 hydrocephalus developed in 15 of 17 patients after DC, and 5 required shunting after cranioplasty. Rahme et al1 speculated that the explanation for this discrepancy might lie in the definition of hydrocephalus and the indications for shunting. We completely agree with the viewpoint of Rahme et al1; however, we wish to provide further comment on this issue. Bogousslavsky and Regli3 reported that, in 60 cases of internal carotid artery occlusion, the occurrence of ventricular dilation was related to the volume of infarction. Additionally, Barber et al4 reported that hydrocephalus was present in 22% of patients who had a large middle cerebral artery infarction, and they received conventional medical therapy (without surgery). Therefore, we believe that the possibility of hydrocephalus developing in the course of a large infarction should be considered. From this viewpoint, we consider that an additional explanation for the discrepancy between the results of Rahme et al1 and Waziri et al2 might be differences in the area and volume of the infarction. Indeed, in the Waziri et al series, all 4 patients with internal carotid artery infarction developed hydrocephalus after DC (half required shunting), and none of the 7 patients with middle cerebral artery infarction received shunting, whereas the Rahme et al series included no patients with internal carotid artery infarction.1 Satoru Takeuchi Naoki Otani Hiroshi Nawashiro Tokorozawa, Saitama, Japan