Open Access, Peer-reviewed
pISSN 2234-8999  eISSN 2288-2243
    Korean J Neurotrauma. 2012 Oct;8(2):110-114. Korean.
    Published online Oct 31, 2012.
    https://doi.org/10.13004/kjnt.2012.8.2.110
    Copyright © 2012 Korean Neurotraumatology Society
    Original Article

    Risk Factors for the Post-Traumatic Hydrocephalus Following Decompressive Craniectomy in Severe Traumatic Injury Patients

    Byung-Rae Cho, MD, Hyung-Jin Lee, MD, Hong-Jae Lee, MD, Jin-Seok Yi, MD, Ji-Ho Yang, MD and Il-Woo Lee, MD
      • Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
    • Address for correspondence: Hyung-Jin Lee, MD. Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, 64 Daeheung-ro, Jung-gu, Daejeon 301-010, Korea. Tel: +82-42-220-9525, Fax: +82-42-222-6601, Email: kope95@hanmail.net
    Received July 25, 2012; Revised September 05, 2012; Accepted September 06, 2012.

    Abstract

    Objective

    The goal of this study was to assess the incidence and risk factors for post-traumatic hydrocephalus (PTH) following decompressive craniectomy (DC). An additional objective was to investigate the relationship between hydrocephalus and subdural hygroma (SDG) after DC.

    Methods

    We conducted a retrospective study of 94 patients who were admitted to our department between 2007 and 2010 with severe head injury requiring DC. Post-traumatic hydrocephalus was defined as: frontal horn index (FHI) ≥0.4 or modified FHI ≥0.33 accompanying transependymal edema; the presence of either clinical worsening or failure to make neurological improvement over time; and clinical improvement after ventriculoperitoneal shunt. Post-traumatic SDG was defined as the presence of low density at computerized tomography (CT) of more than 5mm thickness.

    Results

    Among the 94 patients, we could follow up more than 3 months and obtain more than 4 serial CT scans in 41 patients. PTH developed in 29.3% (12/41) and SDG developed in 48.8% (20/41) of these patients. The development of PTH was significantly associated with delayed craniplasty after DC and with interhemispheric SDG. No relationship was found between PTH and age, sex, Glasgow Coma Scale (GCS) score, intraventricular hemorrhage, subarachnoid hemorrhage, midline shift, basal cistern effacement, or cortical opening during DC.

    Conclusion

    Hydrocephalus occurred in 29.3% of the patients with severe traumatic brain injury who required DC. Delayed cranioplasty and interhemispheric SDG after DC were risk factors for the development of PTH.

    Keywords
    Decompressive craniectomy; Hydrocephalus; Subdural hygroma

    Figures

    FIGURE 1
    Computerized tomography (CT) findings of a patient with severe traumatic injury. A: Initial CT showing multiple contusion and midline shift; the patient's initial Glasgow Coma Scale score was 9. B: CT was performed at 6 days after decompressive craniectomy. C: CT at 28 days after decompressive craniectomy showing interhemispheric subdural hygroma. D: Patient needed ventriculoperitoneal shunt due to hydrocephalus.

    Tables

    TABLE 1
    Summary of the characteristics in 41 patients with or without hydrocephalus following decompressive craniectomy for severe traumatic head injury

    Notes

    The authors have no financial conflicts of interest.

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    MeSH Terms
    Animals
    Brain Injuries
    Craniocerebral Trauma
    Decompressive Craniectomy
    Follow-Up Studies
    Glasgow Coma Scale
    Hemorrhage
    Horns
    Humans
    Hydrocephalus
    Incidence
    Retrospective Studies
    Risk Factors
    Subarachnoid Hemorrhage
    Subdural Effusion
    Ventriculoperitoneal Shunt
    Metrics
    Share
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