Risk Factors For Hydrocephalus Research Articles

Risk factors of postoperative hydrocephalus following decompressive craniectomy for spontaneous intracranial hemorrhages and intraventricular hemorrhage.

Introduction:Hydrocephalus is a complication of spontaneous intracerebral hemorrhage; however, its predictive relationship with hydrocephalus in this patient cohort is not understood. Here, we evaluated the incidence and risk factors of hydrocephalus after craniectomy.Methods:Retrospectively studied data from 39 patients in the same hospital from 2016/01 to 2020/12 and analyzed risk factors for hydrocephalus. The clinical data recorded included patient age, sex, timing of surgery, initial Glasgow Coma Scale score, intracerebral hemorrhage (ICH) score, alcohol consumption, cigarette smoking, medical comorbidity, and blood data. Predictors of patient outcomes were determined using Student t test, chi-square test, and logistic regression.Results:We recruited 39 patients with cerebral herniation who underwent craniectomy for spontaneous supratentorial hemorrhage. Persistent hydrocephalus was observed in 17 patients. The development of hydrocephalus was significantly associated with the timing of operation, cigarette smoking, and alcohol consumption according to the Student t test and chi-square test. Univariate and multivariate analyses suggested that postoperative hydrocephalus was significantly associated with the timing of surgery (P = .031) and cigarette smoking (P = .041).Discussion:The incidence of hydrocephalus in patients who underwent delayed operation (more than 4 hours) was lower than that in patients who underwent an operation after less than 4 hours. nonsmoking groups also have lower incidence of hydrocephalus. Among patients who suffered from spontaneous supratentorial hemorrhage and need to receive emergent craniectomy, physicians should be reminded that postoperative hydrocephalus followed by ventriculoperitoneal shunting may be necessary in the future.

Logistic Regression Analysis of Relationship between Changes of Cerebrospinal Fluid and Communicating Hydrocephalus after Decompressive Craniectomy in Craniocerebral Injury under Computed Tomography Images

This paper aimed to explore the application value of CT imaging in the correlation analysis of communicating hydrocephalus (CH) after decompressive craniectomy (DC) of craniocerebral injury (CI). 410 patients with craniocerebral trauma who were admitted to the hospital from October 2015 to October 2019 were taken as subjects, among which 130 patients suffered from CH. All patients underwent craniocerebral CT examination, and logistic regression was applied to analyze the risk factors of hydrocephalus in CI and hydrocephalus after DC surgery. The results showed that the coma time (OR = 5.1283, P = 0.001 ), subarachnoid hemorrhage (SAH) (OR = 7.6543, P = 0.020 ), Glasgow Coma Scale (GCS) score no more than 8 points (OR = 3.5480, P = 0.001 ), intraventricular hemorrhage (OR = 2.2653, P = 0.003 ), cerebral contusion and laceration (OR = 1.036, P = 0.002 ), and subdural hemorrhage (OR = 2.4376, P = 0.001 ) were independent risk factors for CH. Bilateral DC (OR = 15.342, P = 0.023 ), second surgery (OR = 7.021, P = 0.004 ), bone window height (OR = 6.543, P = 0.041 ), and bone window area (OR = 1.035, P = 0.012 ) were independent risk factors for CH after DC surgery. It suggested that CT imaging technology could be utilized in the diagnosis of CI. The risk factors of CH included coma time, SAH, GCS score no more than 8, intraventricular hemorrhage, brain contusion, subdural hematoma, bilateral DC, bone window height, bone window area, and second surgery.

Risk factors for hydrocephalus following fourth ventricle tumor surgery: A retrospective analysis of 121 patients

Most patients who present with a fourth ventricle tumor have concurrent hydrocephalus, and some demonstrate persistent hydrocephalus after tumor resection. There is still no consensus on the management of hydrocephalus in patients with fourth ventricle tumor after surgery. The purpose of this study was to identify the factors that predispose to postoperative hydrocephalus and the need for a postoperative cerebrospinal fluid (CSF) diversion procedure. We performed a retrospective analysis of patients who underwent surgery of the fourth ventricle tumor between January 2013 and December 2018 at the Department of Neurosurgery in West China Hospital of Sichuan University. The characteristics of patients and the tumor location, tumor size, tumor histology, and preventive external ventricular drainage (EVD) that were potentially correlated with CSF circulation were evaluated in univariate and multivariate analysis. A total of 121 patients were enrolled in our study; 16 (12.9%) patients underwent postoperative CSF drainage. Univariate analysis revealed that superior extension (p = 0.004), preoperative hydrocephalus (p<0.001), and subtotal resection (p<0.001) were significantly associated with postoperative hydrocephalus. Multivariate analysis revealed that superior extension (p = 0.013; OR = 44.761; 95% CI 2.235-896.310) and subtotal resection (p = 0.005; OR = 0.087; 95% CI 0.016-0.473) were independent risk factors for postoperative hydrocephalus after resection of fourth ventricle tumor. Superior tumor extension (into the aqueduct) and failed total resection of tumor were identified as independent risk factors for postoperative hydrocephalus in patients with fourth ventricle tumor.

Analysis on risk factors for hydrocephalus after traumatic brain injury

Objective To investigate the risk factors for post-traumatic hydrocephalus (PTH) after traumatic brain injury (TBI). Methods A retrospective case control analysis was made on the clinical data of 794 patients with acute TBI admitted to Shenzhen Second People's Hospital between January 2007 and January 2017. There were 639 males and 155 females, aged 1-90 years [(40.5±18.6)years]. All patients were followed up for 1 years, and the patients were divided into PTH group (n=46) and non-PTH group (n=748) according to their prognosis. The following information including Glasgow coma score (GCS) on admission, pupil reflex, midline shift and cistern compression, subarachnoid hemorrhage (SAH), operation method, decompressive craniectomy, hydrocephalus after operation, intracranial infection, timing of cranioplasty were analyzed using univariate analysis and Logistic regression. Results PTH occurred in 46 patients (5.8%). Univariate analysis showed that GCS, midline shift, decompressive craniectomy, subdural effusion, timing of cranioplasty and SAH were significantly related to PTH (P<0.05 or 0.01). Logistic regression identified low GCS (OR=3.778), decompressive craniectomy (OR=2.508), subdural effusion (OR=2.269), timing of cranioplasty (≥3 months)(OR=10.478) and SAH (OR=23.391) as the independent risk factors for PTH (P<0.05 or 0.01). Conclusion PTH is a common serious complication of traumatic brain injury, affected by low GCS, decompressive craniectomy, subdural effusion, delayed cranioplasty and SAH. Key words: Brain injuries; Hydrocephalus; Risk factors

The relationship between the area of decompressive craniectomy and normal pressure hydrocephalus after traumatic brain injury

Objective To analyze the effect of craniotomy area on the development of normal pressure hydrocephalus after decompressive craniotomy. Methods The clinical data of 34 patients with traumatic brain injury who underwent unilateral craniotomy from January 2012 to April 2018 at Department of Neurosurgery, Tangdu Hospital, Airforce Military Medical University were retrospectively analyzed. The effects of multiple factors on hydrocephalus, including the gender, age, Glasgow coma scale before craniotomy, open injury, extent of midline shift on CT before craniectomy, duration of operation, intracranial pressure after craniotomy, cerebrospinal fluid infection and craniotomy area were analyzed. Results Univariate analysis showed that the age (P=0.016), preoperative Glasgow coma scale (P=0.018), craniotomy area (P 0.05). It was also suggested by multiple logistic regression that craniotomy area (OR=1.138, 95% CI: 1.005-1.288, P=0.042) was an independent risk factor for hydrocephalus. Conclusion After decompressive craniotomy, the skull defect area may increase the risk of hydrocephalus. Key words: Craniocerebral trauma; Hydrocephalus, normal pressure; Decompressive craniectomy; Area size of craniectomy; Cerebrospinal fluid dynamics

212 Hydrocephalus in Pediatric Traumatic Brain Injury

Abstract INTRODUCTION Hydrocephalus is a well-known and life-threatening sequel of traumatic brain injury (TBI) in adults, but is not as well characterized in children. We investigated the national incidence, risk factors, and outcomes associated with hydrocephalus in pediatric TBI. METHODS The Kids Inpatient Database (KID) is the largest pediatric hospital database in the U.S. and is sampled every 3 years. We queried the KID 2003, 2006, 2009, and 2012 using ICD-9-CM codes to identify all patients (age 0–20) with a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis code for hydrocephalus (331.3-331.5, excluding congenital hydrocephalus [742.3]. Variables included demographics, comorbidities, TBI severity (consciousness, type of wound) complications (medical or neurological), and discharge outcomes. Both univariate and multivariable analysis was utilized to identify factors associated with hydrocephalus and alpha was set at P &lt; 0.05. RESULTS &gt;In 124,444 patients hospitalized for TBI. The average rate of hydrocephalus was 1.0% but was affected by the type of TBI: subdural hematoma (2.4%), subarachnoid hemorrhage (1.4%), epidural hematoma (1.0%), cerebral laceration (0.9%), concussion (0.2%). The risk factors for hydrocephalus in multivariable analysis were age 0–5 (compared to other ages), Medicaid insurance, electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication, and septicemia (all P &lt; 0.05). The likelihood of hydrocephalus was increased among surgically managed patients (6.0% vs. 0.5%) but decreased among those who underwent operation on admission day (0.8% vs. 4.1%) (both P &lt; 0.05). The mortality rate for TBI patients without hydrocephalus was higher (5.4%) than those with hydrocephalus (1.1%). However, average LOS (25 vs. 5 days) and mean total hospital costs ($86,596 vs. $16,791) were greater among patients with hydrocephalus. CONCLUSION Hydrocephalus following TBI in children is relatively uncommon but is more likely in patients with certain demographics, pre-existing comorbidities, and injury patterns and attracts a higher total hospital cost.

Risk factors for hydrocephalus after moderate to severe traumatic brain injury

Objective To investigate the risk factors of posttraumatic hydrocephalus (PTH) in patients with moderate to severe traumatic brain injury (TBI). Methods Aretrospective study was conducted for 183 patients with moderate to severe TBI (125 males, 58 females; 6-91 years of age, mean 48.23 years). According the presence of PTH, the patients were allocated into PTH group (n=34) and non-PTH group (n=149). Risk factors of PTH were assessed by univariate and logistic regression analysis, including gender, age, injury types, injury severity, intraventricular hemorrhage, subarachnoid hemorrhage, midline shift, subdural effusion, therapeutic strategies and skull defect. Association between the boundaries of skull defect and PTH was determined. Results Between-group differences were not significant regarding age, gender, injury types and intraventricular hemorrhage (P>0.05), but differed significantly in injury severity, subarachnoid hemorrhage, midline shift, subdural effusion, craniectomy and skull defect (P<0.05). Further Logistic regression analysis confirmed subarachnoid hemorrhage(OR=6.169), interhemispheric subdural effusion(OR=31.743), and unilateral (OR=17.602)and bilateral(OR=30.567)skull defects were risk factors of PTH. Of the patients with unilateral skull defect following decompressive craniectomy, the inferior limit ≤10 mm from the zygomatic arch also played a role in the development of PTH (OR=5.500, P<0.05). Conclusions Subarachnoid hemorrhage, interhemispheric subdural effusion and skull defect are risk factors of PTH. Unilateral skull defects with the inferior limit too close to the zygomatic arch can predispose to the development of PTH. Key words: Hydrocephalus; Risk factors; Decompression, surgical; Subdural effusion

Hydrocephalus after decompressive craniectomy for malignant hemispheric cerebral infarction

Purpose: Several studies have investigated the incidence and risk factors of hydrocephalus after decompressive craniectomy (DC) for malignant hemispheric cerebral infarction. However, the results are controversial. Therefore, the following is a retrospective cohort study to determine the incidence and risk factors of hydrocephalus after DC for malignant hemispheric cerebral infarction. Materials and methods: From January 2004 to June 2014, patients at two medical centres in south-west China, who underwent DC for malignant hemispheric cerebral infarction, were included. The patients’ clinical and radiologic findings were retrospectively reviewed. A chi-square test, Mann–Whitney U-test and logistic regression model were used to identify the risk factors. Results: A total of 128 patients were included in the study. The incidence of ventriculomegaly and shunt-dependent hydrocephalus were 42.2% (54/128) and 14.8% (19/128), respectively. Lower preoperative Glasgow Coma Scale (GCS) score and presence of subarachnoid haemorrhage (SAH) were factors significantly associated with the development of post-operative hydrocephalus after DC. Conclusions: Cerebral infarction patients receiving DC have a moderate tendency to suffer from post-operative hydrocephalus. A poor GCS score and the presence of SAH were significantly associated with the development of hydrocephalus after DC.

Risk factors for hydrocephalus and neurological deficit in children born with an encephalocele

There is a known association of hydrocephalus with encephaloceles. Risk factors for hydrocephalus and neurological deficit were ascertained in a series of patients born with an encephalocele. A retrospective analysis was undertaken of patients treated for encephaloceles at Children's Hospital Los Angeles between 1994 and 2012. The following factors were evaluated for their prognostic value: age at presentation, sex, location of encephalocele, size, contents, microcephaly, presence of hydrocephalus, CSF leak, associated cranial anomalies, and neurological outcome. Seventy children were identified, including 38 girls and 32 boys. The median age at presentation was 2 months. The mean follow-up duration was 3.7 years. Encephalocele location was classified as anterior (n = 14) or posterior (n = 56) to the coronal suture. The average maximum encephalocele diameter was 4 cm (range 0.5-23 cm). Forty-seven encephaloceles contained neural tissue. Eight infants presented at birth with CSF leaking from the encephalocele, with 1 being infected. Six patients presented with hydrocephalus, while 11 developed progressive hydrocephalus postoperatively. On univariate analysis, the presence of neural tissue, cranial anomalies, encephalocele size of at least 2 cm, seizure disorder, and microcephaly were each positively associated with hydrocephalus. On multivariate logistic regression modeling, the single prognostic factor for hydrocephalus of borderline statistical significance was the presence of neural tissue (odds ratio [OR] = 5.8, 95% confidence interval [CI] = 0.8-74.0). Fourteen patients had severe developmental delay, 28 had mild/moderate delay, and 28 were neurologically normal. On univariate analysis, the presence of cranial anomalies, larger size of encephalocele, hydrocephalus, and microcephaly were positively associated with neurological deficit. In the multivariable model, the only statistically significant prognostic factor for neurological deficit was presence of hydrocephalus (OR 17.2, 95% CI 1.7-infinity). In multivariate models, the presence of neural tissue was borderline significantly associated with hydrocephalus and the presence of hydrocephalus was significantly associated with neurological deficit. The location of the encephalocele did not have a statistically significant association with incidence of hydrocephalus or neurological deficit. In contrast to modestly good/fair neurological outcome in children with an encephalocele without hydrocephalus, the presence of hydrocephalus resulted in a far worse neurological outcome.

The Risk Factors for Hydrocephalus and Subdural Hygroma after Decompressive Craniectomy in Head Injured Patients.

ObjectiveThe present study aims to investigate 1) the risk factors for hydrocephalus and subdural hygroma (SDG) occurring after decompressive craniectomy (DC), and 2) the association between the type of SDG and hydrocephalus.MethodsWe retrospectively reviewed the clinical and radiological features of 92 patients who underwent DC procedures after severe head injuries. The risk factors for developing post-traumatic hydrocephalus (PTH) and SDG were analyzed. Types of SDGs were classified according to location and their relationship with hydrocephalus was investigated.ResultsUltimately, 26.09% (24/92) of these patients developed PTH. In the univariate analyses, hydrocephalus was statically associated with large bone flap diameter, large craniectomy area, bilateral craniectomy, intraventricular hemorrhage, contralateral or interhemisheric SDGs, and delayed cranioplasty. However, in the multivariate analysis, only large craniectomy area (adjusted OR=4.66; p=0.0239) and contralateral SDG (adjusted OR=6.62; p=0.0105) were significant independent risk factors for developing hydrocephalus after DC. The incidence of overall SDGs after DC was 55.43% (51/92). Subgroup analysis results were separated by SDG types. Statistically significant associations between hydrocephalus were found in multivariate analysis in the contralateral (adjusted OR=5.58; p=0.0074) and interhemispheric (adjusted OR=17.63; p=0.0113) types.ConclusionFor patients who are subjected to DC following severe head trauma, hydrocephalus is associated with a large craniectomy area and contralateral SDG. For SDGs after DC that occur on the interhemispherical or controlateral side of the craniectomy, careful follow-up monitoring for the potential progression into hydrocephalus is needed.

Risk factors for hydrocephalus after periventricular-intraventricular hemorrhages in premature infants

Objective To study the risk factors for secondary hydrocephalus after periventricular-intraventricular hemorrhage(PVH-IVH)in premature infants. Methods From Jun.2007 to Jun.2012, 214 premature infants who were admitted to the Neonatal Intensive Care Unit after birth were enrolled and head ultrasonography showed PVH-IVH from 3 to 7 days after birth.They were classified into PVH-IVH alone group (n=161) and secondary hydrocephalus after PVH-IVH group (n=53) based on the different prognosis.Single factor and multivariate Logistic regression analysis were used to identify risk factors for secondary hydrocephalus after PVH-IVH. Results Single analysis indicated 8 factors associated with hydrocephalus after PVH-IVH, including male, gestational age <28 weeks, birth weight <1000 g, severe asphyxia, PVH-IVH Ⅲ or Ⅳ, metabolic acidosis, hyponatremia, and hypoglycemia or hyperglycemia (all P<0.05); multivariate Logistic regression analysis showed that male (OR=3.317), severe asphyxia (OR=13.838), PVH-IVH ⅢorⅣ(OR=43.281), and hyponatremia (OR=2.731) were independent risk factors for hydrocephalus after PVH-IVH (all P<0.05 ). Conclusions Male, severe asphyxia, PVH-IVH Ⅲ or Ⅳ, and hyponatremia are closely related to hydrocephalus after PVH-IVH in preterm infants.After PVH-IVH, these clinical risk factors should be followed closely in the prevention of hydrocephalus. Key words: Periventricular-intraventricular hemorrhage; Hydrocephalus; Risk factor; Premature infant

Risk factors and tumor response associated with hydrocephalus after gamma knife radiosurgery for vestibular schwannoma

This study was designed to investigate the clinical characteristics and risk factors of hydrocephalus after gamma knife radiosurgery (GKRS) for vestibular schwannoma. The authors retrospectively reviewed clinical and neuroimaging findings of 221 patients who underwent GKRS for newly diagnosed vestibular schwannoma. Mean patient age was 54.1 years (range 7-83 years), mean tumor volume was 3,010.4 mm(3) (range 34.7 to 14,300 mm(3)), mean marginal dose was 12.5 Gy (range 11 to 15 Gy), and mean follow-up duration was 31.9 months (range 1 to 107.6 months). Surgical intervention for cerebrospinal fluid (CSF) diversion after GKRS was necessary in 11 (5 %) of the patients. Median time between GKRS and ventriculoperitoneal (VP) shunt placement was 15.5 months (range 1.8-37.8 months). These 11 patients showed female predominance (11 females) and mean tumor volume was significantly larger than in the other without hydrocephalus (6,509 vs. 2,726 mm(3); p < 0.01). Decreases in tumor enhancement and swelling were observed in all 221 patients, and CSF protein was found to be elevated in five of nine patients with available data at the time of the shunt procedure. Hydrocephalic symptoms improved after VP shunt and tumor sizes further decreased at last follow-up in all patients. Hydrocephalus after radiosurgery may co-occur with a temporary change of tumor volume after radiation treatment. Therefore, hydrocephalus should be kept in mind during the time of tumor volume transition. Furthermore, the authors suggest that frequent patient monitoring for hydrocephalus be maintained for up to 3-4 years after GKRS.

In Reply:

We thank De Bonis et al for their interest in our article.1 In our series of 17 patients who underwent decompressive hemicraniectomy (DH) for cerebrovascular accident-related, medically refractory increased intracranial pressure, a full standard hemicraniectomy was performed in 13 patients, whereas only 4 received large craniectomy flaps. Clinically significant hydrocephalus necessitating cerebrospinal fluid (CSF) diversion developed in none of the 14 survivors. Unfortunately, we are unable to provide the authors with the information that they request because exact measurements of the hemicraniectomy flaps, particularly the distance between their medial edge and the superior sagittal sinus, were difficult to determine in our retrospective study. However, it has been our standard practice to perform wide bony decompressions extending from the floor of the middle fossa laterally to within 1 to 2 cm of the sagittal suture medially and from the floor of the anterior fossa anteriorly to approximately 5 to 6 cm behind the pinna posteriorly.2 Therefore, we would expect that the vast majority of patients in our series had hemicraniectomy flaps extending to within 2.5 cm of the superior sagittal sinus. When analyzing the incidence of hydrocephalus after DH, it is important to distinguish between complications of the underlying cerebral insult and those resulting from the surgical procedure itself. This is particularly true in patients with head trauma and those with subarachnoid and/or intraventricular hemorrhage who are naturally prone to the development of hydrocephalus, regardless of whether DH is performed. For this reason, we have strived to eliminate these major confounding factors and exclude such patients from our analysis. We read the authors' recent article on posttraumatic hydrocephalus after decompressive craniectomy in patients with traumatic brain injury.3 Although we find the authors' hypothesis interesting in general, there are nonetheless several issues that merit discussion. Their patient cohort was particularly small, with only 26 survivors included in the final analysis. Such a small sample size is unlikely to have a high enough statistical power to allow firm conclusions regarding prognostic factors, particularly when a 6-variable multivariate analysis is performed. Moreover, numerical variables were not analyzed as such and instead were dichotomized using arbitrary cutoff values (30 d for cranioplasty, 40 yr for age, 162 cm2 for cranioplasty, and 25 mm for distance from midline). This raises significant concerns about the validity of their statistical analysis. Clinical examination was not included in the definition of hydrocephalus for many comatose patients, which may have significantly affected their results. In our series, in 2 patients, asymptomatic extra-axial CSF collections developed after DH, which resolved spontaneously after cranioplasty. We believe that such collections are the result of increased intracranial compliance after the removal of a large piece of cranium rather than an actual mismatch between CSF production and absorption.1 Most importantly, the presence of a statistically significant association between a DH extending close to midline and hydrocephalus is in no way proof of a causal relationship, particularly in severely head-injured patients. It is noteworthy that all but 2 of their patients had evidence of subarachnoid and/or intraventricular blood on computed tomography (Fisher grade 2). A major confounding factor was thus present in the absolute majority of patients, which makes it difficult to attribute the development of hydrocephalus to the surgical procedure itself. Is it possible that patients who underwent DH closer to the midline had more severe structural damage to the cerebral hemisphere on CT, which may account for their increased rate of posttraumatic hydrocephalus? This is definitely a possibility in the setting of a retrospective study that may be subject to all kinds of inherent biases. In conclusion, to establish a cause-and-effect relationship between DH and hydrocephalus, one has to study the incidence of the latter in patients undergoing DH for conditions not known to be associated with hydrocephalus (eg, ischemic stroke). Alternatively, a randomized, controlled trial comparing the incidence of hydrocephalus in severe traumatic brain injury survivors who underwent DH and those who did not may provide the answer. Until then, we have no reason to believe that DH is a risk factor for hydrocephalus, independently of the patient's underlying cerebral insult. Michel Bojanowski Ralph Rahme Montreal, Quebec

Risk factors related to hydrocephalus after traumatic subarachnoid hemorrhage

Background Posttraumatic hydrocephalus is a common complication of head injury. However, hydrocephalus after tSAH has seldom been addressed. We present this clinical study to determine the incidence of hydrocephalus and analyze the risk factors for developing hydrocephalus in patients with tSAH. Methods A consecutive series of 301 patients with tSAH were retrospectively reviewed to determine the effects of the admission GCS score, age, sex, decompressive craniectomy, intraventricular hemorrhage, and features of tSAH (according to the initial computerized tomography scans) on the development of hydrocephalus. Risk factors for hydrocephalus were evaluated by using logistic regression analysis. Results Of the 301 patients, hydrocephalus was observed in 36 (11.96%). Increasing age ( P < .05), intraventricular hemorrhage ( P < .05), and thickness ( P < .01) or distribution ( P < .05) of tSAH were significantly associated with the development of hydrocephalus. No relationship was found between hydrocephalus and sex, admission GCS score, location of tSAH, or decompressive craniectomy. Conclusion Hydrocephalus frequently occurs in patients with tSAH. Increasing age, low GCS score on admission, intraventricular hemorrhage, and severe SAH could be risk factors for facilitating the development of hydrocephalus.