Top

Acta Neurochirurgica

Published in:

01-12-2024 | Hydrocephalus | Original Article

Clinical impact of craniectomy on shunt-dependent hydrocephalus after intracerebral hemorrhage: A propensity score-matched analysis

Authors: Shin Heon Lee, Myeong Jin Ko, Young-Seok Lee, Joon Cho, Yong-sook Park

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Purpose

A consensus on decompressive craniectomy for intracerebral hemorrhage (ICH) has not yet been established. We aimed to investigate the development of shunt-dependent hydrocephalus based on the method of ICH surgery, with a focus on craniectomy.

Methods

We retrospectively enrolled 458 patients with supratentorial ICH who underwent surgical hematoma evacuation between April 2005 and December 2021 at two independent stroke centers. Multivariate analyses were performed to characterize risk factors for postoperative shunt-dependent hydrocephalus. Propensity score matching (1:2) was undertaken to compensate for group-wise imbalances based on probable factors that were suspected to affect the development of hydrocephalus, and the clinical impact of craniectomy on shunt-dependent hydrocephalus was evaluated by the matched analysis.

Results

Overall, 43 of the 458 participants (9.4%) underwent shunt procedures as part of the management of hydrocephalus after ICH. Multivariate analysis revealed that intraventricular hemorrhage (IVH) and craniectomy were associated with shunt-dependent hydrocephalus after surgery for ICH. After propensity score matching, there were no statistically significant intergroup differences in participant age, sex, hypertension status, diabetes mellitus status, lesion location, ICH volume, IVH occurrence, or IVH severity. The craniectomy group had a significantly higher incidence of shunt-dependent hydrocephalus than the non-craniectomy group (28.9% vs. 4.3%, p < 0.001; OR 9.1, 95% CI 3.7–22.7), craniotomy group (23.2% vs. 4.3%, p < 0.001; OR 6.6, 95% CI 2.5–17.1), and catheterization group (20.0% vs. 4.0%, p = 0.012; OR 6.0, 95% CI 1.7–21.3).

Conclusion

Decompressive craniectomy seems to increase shunt-dependent hydrocephalus among patients undergoing surgical ICH evacuation. The decision to perform a craniectomy for patients with ICH should be carefully individualized while considering the risk of hydrocephalus.

Available only for authorised users

Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF, American Heart Association, American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups (2007) Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 38:1655–1711https://doi.org/10.1161/STROKEAHA.107.181486

Akins PT, Guppy KH (2008) Sinking skin flaps, paradoxical herniation, and external brain tamponade: A review of decompressive craniectomy management. Neurocrit Care 9:269–276. https://doi.org/10.1007/s12028-007-9033-zCrossRefPubMed

Akins PT, Guppy KH (2019) Are hygromas and hydrocephalus after decompressive craniectomy caused by impaired brain pulsatility, cerebrospinal fluid hydrodynamics, and glymphatic drainage? Literature overview and illustrative cases. World Neurosurg 130:e941–e952. https://doi.org/10.1016/j.wneu.2019.07.041CrossRefPubMed

Akins PT, Guppy KH (2021) Does impaired glymphatic drainage cause glymphedema? A review tailored to neurocritical care and neurosurgery. Neurocrit Care 35:545–558. https://doi.org/10.1007/s12028-021-01224-1CrossRefPubMedPubMedCentral

Aronowski J, Zhao X (2011) Molecular pathophysiology of cerebral hemorrhage: Secondary brain injury. Stroke 42:1781–1786. https://doi.org/10.1161/STROKEAHA.110.596718CrossRefPubMedPubMedCentral

Ban SP, Son YJ, Yang HJ, Chung YS, Lee SH, Han DH (2010) Analysis of complications following decompressive craniectomy for traumatic brain injury. J Korean Neurosurg Soc 48:244–250. https://doi.org/10.3340/jkns.2010.48.3.244CrossRefPubMedPubMedCentral

Benveniste H, Nedergaard M (2022) Cerebral small vessel disease: A glymphopathy? Curr Opin Neurobiol 72:15–21. https://doi.org/10.1016/j.conb.2021.07.006CrossRefPubMed

Bhattathiri PS, Gregson B, Prasad KS, Mendelow AD, Investigators STICH (2006) Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: Results from the STICH trial. Acta Neurochir Suppl (Wien) 96:65–68. https://doi.org/10.1007/3-211-30714-1_16CrossRef

De Bonis P, Sturiale CL, Anile C, Gaudino S, Mangiola A, Martucci M, Colosimo C, Rigante L, Pompucci A (2013) Decompressive craniectomy, interhemispheric hygroma and hydrocephalus: A timeline of events? Clin Neurol Neurosurg 115:1308–1312. https://doi.org/10.1016/j.clineuro.2012.12.011CrossRefPubMed

10.

Diringer MN, Edwards DF, Zazulia AR (1998) Hydrocephalus: A previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke 29:1352–1357. https://doi.org/10.1161/01.STR.29.7.1352CrossRefPubMed

11.

Fattahian R, Bagheri SR, Sadeghi M (2018) Development of posttraumatic hydrocephalus requiring ventriculoperitoneal shunt after decompressive craniectomy for traumatic brain injury: a systematic review and meta-analysis of retrospective studies. Med Arh 72:214–219. https://doi.org/10.5455/medarh.2018.72.214-219CrossRef

12.

Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC III, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS, Association AH, Association AS (2022) 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association. Stroke 53:e282–e361. https://doi.org/10.1161/STR.0000000000000407CrossRefPubMed

13.

Gooch MR, Gin GE, Kenning TJ, German JW (2009) Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 26:E9. https://doi.org/10.3171/2009.3.FOCUS0962CrossRefPubMed

14.

Hayes SB, Benveniste RJ, Morcos JJ, Aziz-Sultan MA, Elhammady MS (2013) Retrospective comparison of craniotomy and decompressive craniectomy for surgical evacuation of nontraumatic, supratentorial intracerebral hemorrhage. Neurosurg Focus 34:E3. https://doi.org/10.3171/2013.2.FOCUS12422CrossRefPubMed

15.

Hayman EG, Wessell A, Gerzanich V, Sheth KN, Simard JM (2017) Mechanisms of global cerebral edema formation in aneurysmal subarachnoid hemorrhage. Neurocrit Care 26:301–310. https://doi.org/10.1007/s12028-016-0354-7CrossRefPubMedPubMedCentral

16.

Ironside N, Chen CJ, Ding D, Mayer SA, Connolly ES Jr (2019) Perihematomal edema after spontaneous intracerebral hemorrhage. Stroke 50:1626–1633. https://doi.org/10.1161/STROKEAHA.119.024965CrossRefPubMed

17.

Kim DB, Park SK, Moon BH, Cho BR, Jang DK, Jang KS (2018) Comparison of craniotomy and decompressive craniectomy in large supratentorial intracerebral hemorrhage. J Clin Neurosci 50:208–213. https://doi.org/10.1016/j.jocn.2018.01.066CrossRefPubMed

18.

Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J (1996) The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:1304–1305. https://doi.org/10.1161/01.STR.27.8.1304CrossRefPubMed

19.

Kurland DB, Khaladj-Ghom A, Stokum JA, Carusillo B, Karimy JK, Gerzanich V, Sahuquillo J, Simard JM (2015) Complications associated with decompressive craniectomy: A systematic review. Neurocrit Care 23:292–304. https://doi.org/10.1007/s12028-015-0144-7CrossRefPubMedPubMedCentral

20.

Liebeskind DS, Jüttler E, Shapovalov Y, Yegin A, Landen J, Jauch EC (2019) Cerebral edema associated with large hemispheric infarction. Stroke 50:2619–2625. https://doi.org/10.1161/STROKEAHA.118.024766CrossRefPubMed

21.

Marinkovic I, Strbian D, Pedrono E, Vekovischeva OY, Shekhar S, Durukan A, Korpi ER, Abo-Ramadan U, Tatlisumak T (2009) Decompressive craniectomy for intracerebral hemorrhage. Neurosurgery 65:780–786. https://doi.org/10.1227/01.NEU.0000351775.30702.A9CrossRefPubMed

22.

Mavrovounis G, Kalogeras A, Brotis A, Iaccarino C, Demetriades AK, Fountas KN (2021) Incidence of post-traumatic hydrocephalus in traumatic brain injury patients that underwent DC versus those that were managed without DC: A systematic review and meta-analysis. Brain Spine 1:100303. https://doi.org/10.1016/j.bas.2021.100303CrossRefPubMedPubMedCentral

23.

Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MD, Barer DH, STICH investigators (2005) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international Surgical Trial in Intracerebral Haemorrhage (STICH): A randomised trial. Lancet 365:387–397. https://doi.org/10.1016/S0140-6736(05)70233-6CrossRefPubMed

24.

Mendelow AD, Gregson BA, Mitchell PM, Murray GD, Rowan EN, Gholkar AR, Investigators STICHII (2011) Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II) protocol. Trials 12:124. https://doi.org/10.1186/1745-6215-12-124CrossRefPubMedPubMedCentral

25.

Miller C, Tsivgoulis G, Nakaji P (2008) Predictors of ventriculoperitoneal shunting after spontaneous intraparenchymal hemorrhage. Neurocrit Care 8:235–240. https://doi.org/10.1007/s12028-007-9018-yCrossRefPubMed

26.

Morgalla MH, Will BE, Roser F, Tatagiba M (2008) Do long-term results justify decompressive craniectomy after severe traumatic brain injury? J Neurosurg 109:685–690. https://doi.org/10.3171/JNS/2008/109/10/0685CrossRefPubMed

27.

Morgan TC, Dawson J, Spengler D, Lees KR, Aldrich C, Mishra NK, Lane K, Quinn TJ, Diener-West M, Weir CJ, Higgins P, Rafferty M, Kinsley K, Ziai W, Awad I, Walters MR, Hanley D, CLEAR and VISTA Investigators (2013) The modified graeb score: An enhanced tool for intraventricular hemorrhage measurement and prediction of functional outcome. Stroke 44:635–641. https://doi.org/10.1161/STROKEAHA.112.670653CrossRefPubMedPubMedCentral

28.

Nalbach SV, Ropper AE, Dunn IF, Gormley WB (2012) Craniectomy-associated progressive extra-axial collections with treated hydrocephalus (CAPECTH): Redefining a common complication of decompressive craniectomy. J Clin Neurosci 19:1222–1227. https://doi.org/10.1016/j.jocn.2012.01.016CrossRefPubMed

29.

Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S (2006) Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: A prospective randomized study. Surg Neurol 66:492–501, discussion 501–502. https://doi.org/10.1016/j.surneu.2006.05.054

30.

Plog BA, Lou N, Pierre CA, Cove A, Kenney HM, Hitomi E, Kang H, Iliff JJ, Zeppenfeld DM, Nedergaard M, Vates GE (2019) When the air hits your brain: decreased arterial pulsatility after craniectomy leading to impaired glymphatic flow. J Neurosurg1–14. https://doi.org/10.3171/2019.2.JNS182675

31.

Rahme R, Zuccarello M, Kleindorfer D, Adeoye OM, Ringer AJ (2012) Decompressive hemicraniectomy for malignant middle cerebral artery territory infarction: Is life worth living? J Neurosurg 117:749–754. https://doi.org/10.3171/2012.6.JNS111140CrossRefPubMed

32.

Sahuquillo J, Arikan F (2006) Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev (1):CD003983. https://doi.org/10.1002/14651858.CD003983.pub2

33.

Shimamura N, Munakata A, Naraoka M, Nakano T, Ohkuma H (2011) Decompressive hemi-craniectomy is not necessary to rescue supratentorial hypertensive intracerebral hemorrhage patients: Consecutive single-center experience. Acta Neurochir Suppl (Wien) 111:415–419. https://doi.org/10.1007/978-3-7091-0693-8_71CrossRef

34.

Sumer MM, Açikgöz B, Akpinar G (2002) External ventricular drainage for acute obstructive hydrocephalus developing following spontaneous intracerebral haemorrhages. Neurol Sci 23:29–33. https://doi.org/10.1007/s100720200020CrossRefPubMed

35.

Takeuchi S, Wada K, Nagatani K, Otani N, Mori K (2013) Decompressive hemicraniectomy for spontaneous intracerebral hemorrhage. Neurosurg Focus 34:E5. https://doi.org/10.3171/2013.2.FOCUS12424CrossRefPubMed

36.

Tuhrim S, Horowitz DR, Sacher M, Godbold JH (1999) Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med 27:617–621. https://doi.org/10.1097/00003246-199903000-00045CrossRefPubMed

37.

van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ (2010) Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: A systematic review and meta-analysis. Lancet Neurol 9:167–176. https://doi.org/10.1016/S1474-4422(09)70340-0CrossRefPubMed

38.

Vedantam A, Yamal JM, Hwang H, Robertson CS, Gopinath SP (2018) Factors associated with shunt-dependent hydrocephalus after decompressive craniectomy for traumatic brain injury. J Neurosurg 128:1547–1552. https://doi.org/10.3171/2017.1.JNS162721CrossRefPubMed

39.

Wang J (2010) Preclinical and clinical research on inflammation after intracerebral hemorrhage. Prog Neurobiol 92:463–477. https://doi.org/10.1016/j.pneurobio.2010.08.001CrossRefPubMedPubMedCentral

40.

Waziri A, Fusco D, Mayer SA, McKhann GM II, Connolly ES Jr (2007) Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke. Neurosurgery 61:489–493, discussion 493–494. https://doi.org/10.1227/01.NEU.0000290894.85072.37

41.

Xi G, Hua Y, Bhasin RR, Ennis SR, Keep RF, Hoff JT (2001) Mechanisms of edema formation after intracerebral hemorrhage: Effects of extravasated red blood cells on blood flow and blood-brain barrier integrity. Stroke 32:2932–2938. https://doi.org/10.1161/hs1201.099820CrossRefPubMed

42.

Yamashiro S, Hitoshi Y, Yoshida A, Kuratsu J (2015) Effectiveness of endoscopic surgery for comatose patients with large supratentorial intracerebral hemorrhages. Neurol Med Chir (Tokyo) 55:819–823. https://doi.org/10.2176/nmc.oa.2014-0136CrossRefPubMed

43.

Yang XF, Wen L, Shen F, Li G, Lou R, Liu WG, Zhan RY (2008) Surgical complications secondary to decompressive craniectomy in patients with a head injury: A series of 108 consecutive cases. Acta Neurochir (Wien) 150:1241–1247, discussion 1248. https://doi.org/10.1007/s00701-008-0145-9

44.

Ye Y, Wang Q, Ou W, He J, Zhao Z (2020) Endoscopic surgery without decompressive craniectomy in large putaminal intracerebral hemorrhage: assessment of efficacy and safety. Neurocrit Care 32:392–399. https://doi.org/10.1007/s12028-019-00880-8CrossRefPubMed

45.

Zacharia BE, Vaughan KA, Hickman ZL, Bruce SS, Carpenter AM, Petersen NH, Deiner S, Badjatia N, Connolly ES Jr (2012) Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion. Neurosurg Focus 32:E5. https://doi.org/10.3171/2012.2.FOCUS11372CrossRefPubMed

Title: Clinical impact of craniectomy on shunt-dependent hydrocephalus after intracerebral hemorrhage: A propensity score-matched analysis
Authors: Shin Heon Lee
Myeong Jin Ko
Young-Seok Lee
Joon Cho
Yong-sook Park
Publication date: 01-12-2024
Publisher: Springer Vienna
Keywords: Hydrocephalus
Hydrocephalus
Hydrocephalus
Hematoma
Craniotomy
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-05911-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical impact of craniectomy on shunt-dependent hydrocephalus after intracerebral hemorrhage: A propensity score-matched analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Predictive value of facial motor–evoked potential and electromyography for facial motor function in vestibular schwannoma surgery

High-throughput RNA sequencing identifies the miRNA expression profile, target genes, and molecular pathways contributing to growth of sporadic vestibular schwannomas

Takanori Fukushima 1942 – 2024

Radiofrequency thermocoagulation under neuromonitoring guidance and general anesthesia for treatment of refractory trigeminal neuralgia

Retrogasserian trigeminal radiofrequency-thermorhizotmoy for trigeminal neuralgia

Venous thromboembolism chemical prophylaxis after skull base surgery