Treatment options for posttraumatic hydrocephalus secondary to decompressive craniectomy of severe traumatic brain injury

Abstract

Objective To investigate the surgical plans for post-traumatic hydrocephalus (PTH) after decompressive craniectomy of severe traumatic brain injury. Methods Eighty-nine patients with severe traumatic brain injury that developed PTH after decompressive craniectomy were identified retrospectively. The patients were submitted to early ventriculoperitoneal shunt (V-Ps) -cranioplasty (early group, 17 cases), delayed V-Ps-cranioplasty (delayed group, 22 cases), V-Ps prior to cranioplasty (prior V-Ps group, 31 cases) and V-Ps posterior to cranioplasty (posterior V-Ps group, 19 cases). Consciousness state of patients was evaluated using GCS, GOS and KPS before and after operation. Results of the surgical approaches and associated postoperative complications were recorded. Results Mean period of follow-up was 9 months (range, 6-12 months). There were no significant differences in treatment efficiency [early group: 88%; delayed group: 86%; prior V-Ps group: 90%; posterior V-Ps group: 90%] (P>0.05). Rate of blocked shunt displayed no significant difference as well (P>0.05). Rate of scalp infection in early group was higher than that in prior V-Ps group (18% vs. 7%, P<0.05). Subdural hematoma or effusion incidence in prior V-Ps group (3%) and posterior V-Ps group (5%) were significantly lower than that in early group (12%) and delayed group (10%)(P<0.05). Conclusion In whatever way V-Ps combined with cranioplasty attains good clinical results in treatment of PTH following decompressive craniectomy of severe brain trauma. Key words: Hydrocephalus; Craniocerebral trauma; Cranioplasty