1
|
Missori P, Paolini S, Peschillo S, Mancarella C, Scafa AK, Rastelli E, Martini S, Fattapposta F, Currà A. Temporal Horn Enlargements Predict Secondary Hydrocephalus Diagnosis Earlier than Evans' Index. Tomography 2022; 8:1429-1436. [PMID: 35736863 PMCID: PMC9229633 DOI: 10.3390/tomography8030115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/03/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to identify early radiological signs of secondary hydrocephalus. We retrieved neuroradiological data from scans performed at various times in patients who underwent surgery for secondary hydrocephalus due to severe traumatic brain injury (TBI), subarachnoid haemorrhage (SAH), or brain tumour (BT). Baseline measurements, performed on the earliest images acquired after the neurological event (T0), included Evans’ index, the distance between frontal horns, and the widths of both temporal horns. The next neuroimage that showed an increase in at least one of these four parameters—and that lead the surgeon to act—was selected as an indication of ventricular enlargement (T1). Comparisons of T0 and T1 neuroimages showed increases in Evans’ index, in the mean frontal horn distance, and in the mean right and left temporal horn widths. Interestingly, in T1 scans, mean Evans’ index scores > 0.30 were only observed in patients with BT. However, the temporal horn widths increased up to ten-fold in most patients, independent of Evans’ index scores. In conclusion temporal horn enlargements were the earliest, most sensitive findings in predicting ventricular enlargement secondary to TBI, SAH, or BT. To anticipate a secondary hydrocephalus radiological diagnosis, clinicians should measure both Evans’ index and the temporal horn widths, to avoid severe disability and poor outcome related to temporal lobe damage.
Collapse
Affiliation(s)
- Paolo Missori
- Department of Human Neurosciences, Neurosurgery, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Sergio Paolini
- IRCCS Neuromed-Pozzilli, “Sapienza” University of Rome, 86077 Pozzilli, Italy; (S.P.); (C.M.)
| | - Simone Peschillo
- Department of Neurosurgery, University of Catania, 95124 Catania, Italy;
| | - Cristina Mancarella
- IRCCS Neuromed-Pozzilli, “Sapienza” University of Rome, 86077 Pozzilli, Italy; (S.P.); (C.M.)
| | - Anthony Kevin Scafa
- Department of Human Neurosciences, Neurosurgery, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Emanuela Rastelli
- Department of Radiology, Neuroradiology, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (E.R.); (S.M.)
| | - Stefano Martini
- Department of Radiology, Neuroradiology, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (E.R.); (S.M.)
| | - Francesco Fattapposta
- Department of Human Neurosciences, Neurology, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Antonio Currà
- Academic Neurology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Ospedale A. Fiorini, “Sapienza” University of Rome, 04019 Terracina, Italy;
| |
Collapse
|
2
|
Castellani GB, Miccoli G, Cava FC, Salucci P, Colombo V, Maietti E, Palandri G. From Shunt to Recovery: A Multidisciplinary Approach to Hydrocephalus Treatment in Severe Acquired Brain Injury Rehabilitation. Brain Sci 2021; 12:brainsci12010003. [PMID: 35053746 PMCID: PMC8773713 DOI: 10.3390/brainsci12010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Hydrocephalus among Severe Acquired Brain Injury (SABI) patients remains overlooked during rehabilitation. Methods: A retrospective cohort study was carried out of traumatic and non-traumatic SABI patients with hydrocephalus, consecutively admitted over 9 years in a tertiary referral specialized rehabilitation hospital. Patients were treated with ventriculoperitoneal shunt before or during inpatient rehabilitation and assessed using the Level of Cognitive Functioning Scale and Disability Rating Scale. Logistic regression models were used to identify predictors of post-surgical complications. Linear regression models were used to investigate predictors of hospital length of stay (LOS), disability, and cognitive function. Results: Of the 82 patients, 15 had post-surgical complications and 16 underwent cranioplasty. Shunt placement complication risk was higher when fixed vs. when programmable pressure valves were used. A total of 56.3% achieved functional improvement at discharge and 88.7% improved in cognitive function; of the 82 patients, 56% were discharged home. In multiple regression analyses, higher disability at discharge was related to cranioplasty and longer LOS, while poorer cognitive function was associated with cranioplasty. Increase in LOS was associated with increasing time to shunt and decreasing age. Conclusions: A significant improvement in cognitive and functional outcomes can be achieved. Cranioplasty increased LOS, and fixed pressure valves were related to poorer outcomes.
Collapse
Affiliation(s)
- Giovanna B. Castellani
- Montecatone Rehabilitation Institute, Imola, 40026 Bologna, Italy; (F.C.C.); (P.S.); (V.C.)
- Correspondence: ; Tel.: +39-0542-632-811
| | - Giovanni Miccoli
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, 80138 Naples, Italy;
| | - Francesca C. Cava
- Montecatone Rehabilitation Institute, Imola, 40026 Bologna, Italy; (F.C.C.); (P.S.); (V.C.)
| | - Pamela Salucci
- Montecatone Rehabilitation Institute, Imola, 40026 Bologna, Italy; (F.C.C.); (P.S.); (V.C.)
| | - Valentina Colombo
- Montecatone Rehabilitation Institute, Imola, 40026 Bologna, Italy; (F.C.C.); (P.S.); (V.C.)
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
| | - Giorgio Palandri
- Department of Neurosurgery, Institute of Neurological Sciences of Bologna IRCCS, Bellaria Hospital, 40139 Bologna, Italy;
| |
Collapse
|
3
|
Rufus P, Moorthy RK, Joseph M, Rajshekhar V. Post Traumatic Hydrocephalus: Incidence, Pathophysiology and Outcomes. Neurol India 2021; 69:S420-S428. [PMID: 35102998 DOI: 10.4103/0028-3886.332264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Post-traumatic hydrocephalus (PTH) is a sequel of traumatic brain injury (TBI) that is seen more often in patients undergoing decompressive craniectomy (DC). It is associated with prolonged hospital stay and unfavorable outcomes. Objective To study the incidence and risk factors for development of PTH in patients undergoing DC in our institution and to review the literature on PTH with respect to incidence, risk factors, pathophysiology, and outcomes of management. Methods Data from 95 patients (among 220 patients who underwent DC for TBI and fulfilled the inclusion criteria) over a 5-year period at Christian Medical College, Vellore were collected and analyzed to study the incidence and possible risk factors for development of PTH. A review of the literature on PTH was performed by searching PUBMED resources. Results Thirty (31.6%) out of 95 patients developed post-traumatic ventriculomegaly, of whom seven (7.3%) developed symptomatic PTH, necessitating placement of ventriculoperitoneal shunt (VPS). No risk factor for development of PTH could be identified. The reported incidence of PTH in the literature is from 0.07% to 29%, with patients undergoing DC having a higher incidence. Younger age, subarachnoid hemorrhage, severity of TBI, presence of subdural hygroma, and delayed cranioplasty after DC are the main risk factors reported in the literature. Conclusions PTH occurs in a significant proportion of patients with TBI and can lead to unfavorable outcomes. PTH has to be distinguished from asymptomatic ventriculomegaly as early as possible so that a CSF diversion procedure can be planned early during development of PTH.
Collapse
Affiliation(s)
- Phelix Rufus
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ranjith K Moorthy
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mathew Joseph
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
4
|
Svedung Wettervik T, Lewén A, Enblad P. Post-traumatic hydrocephalus - incidence, risk factors, treatment, and clinical outcome. Br J Neurosurg 2021; 36:400-406. [PMID: 34414834 DOI: 10.1080/02688697.2021.1967289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Post-traumatic hydrocephalus (PTH) is well-known after traumatic brain injury (TBI), but there is limited evidence regarding patient selection for ventriculo-peritoneal (VP)-shunt treatment. In this study, we investigated the incidence and risk factors for PTH and the indication for and outcome after shunt treatment. MATERIALS AND METHODS In this retrospective study, 836 TBI patients, treated at our neurointensive care (NIC) unit at Uppsala university hospital, Sweden, between 2008 and 2018, were included. Demography, admission status, radiology, treatments, and outcome variables were evaluated. RESULTS Post-traumatic ventriculomegaly occurred in 46% of all patients at NIC discharge. Twenty-nine (3.5%) patients received a VP-shunt. Lower GCS M at admission, greater amount of subarachnoid hemorrhage, meningitis, decompressive craniectomy (DC), and ventriculomegaly at NIC discharge were risk factors for receiving a VP-shunt. Fourteen of the PTH patients showed impeded recovery or low-pressure hydrocephalus symptoms, of whom 13 experienced subjective clinical improvement after shunt treatment. Five PTH patients showed deterioration in consciousness, of whom four improved following shunt treatment. Five DC patients received a shunt due to subdural hygromas (n =2) or external brain herniation (n = 3), of whom two patients improved following treatment. Five patients were vegetative with concurrent ventriculomegaly and these patients did not have any positive shunt response. Altogether, 19 (66%) PTH patients improved after shunt surgery. CONCLUSION Post-traumatic ventriculomegaly was common, but few developed symptomatic PTH and received a VP-shunt. Patients with low-pressure hydrocephalus symptoms had the best shunt response, whereas patients with suspected vegetative state exhibited a minimal shunt response.
Collapse
Affiliation(s)
| | - Anders Lewén
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Per Enblad
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| |
Collapse
|
5
|
Missori P, Currà A, Peschillo S, Paolini S. Post-traumatic hydrocephalus after decompressive craniectomy. J Clin Neurosci 2021; 93:268-269. [PMID: 34120791 DOI: 10.1016/j.jocn.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Paolo Missori
- Department of Human Neurosciences, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
| | - Antonio Currà
- Department of Medical-Surgical Sciences and Biotechnologies, Academic Neurology Unit, Ospedale A. Fiorini, Terracina, LT, "Sapienza" University of Rome, Polo Pontino, Italy
| | - Simone Peschillo
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico-S. Marco," University Hospital, Catania, Italy
| | - Sergio Paolini
- IRCCS Neuromed-Pozzilli, "Sapienza" University of Rome, Italy
| |
Collapse
|
6
|
Zasler ND, Aloisi M, Contrada M, Formisano R. Disorders of consciousness terminology: history, evolution and future directions. Brain Inj 2019; 33:1684-1689. [DOI: 10.1080/02699052.2019.1656821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nathan D. Zasler
- Concussion Care Centre of Virginia, LTD; Tree of Life Services, Inc., Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | | | | | | |
Collapse
|
7
|
Posttraumatic Hydrocephalus as a Confounding Influence on Brain Injury Rehabilitation: Incidence, Clinical Characteristics, and Outcomes. Arch Phys Med Rehabil 2016; 98:312-319. [PMID: 27670926 DOI: 10.1016/j.apmr.2016.08.478] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe incidence, clinical characteristics, complications, and outcomes in posttraumatic hydrocephalus (PTH) after traumatic brain injury (TBI) for patients treated in an inpatient rehabilitation program. DESIGN Cohort study with retrospective comparative analysis. SETTING Inpatient rehabilitation hospital. PARTICIPANTS All patients admitted for TBI from 2009 to 2013 diagnosed with PTH (N=59), defined as ventriculomegaly, delayed clinical recovery discordant with injury severity, hydrocephalus symptoms, or positive lumbar puncture results. INTERVENTIONS None. MAIN OUTCOME MEASURES Primary measures were incidence of PTH and patient and injury characteristics. Secondary measures included frequency and timing of ventriculoperitoneal (VP) shunt, related complications, emergence from and duration of posttraumatic amnesia (PTA), Rancho Los Amigos Scale (RLAS) score, and FIM score at rehabilitation admission and discharge. RESULTS Of 701 patients with TBI admitted, 59 (8%) were diagnosed with PTH. Of these, the median age was 25 years, with 73% being men. At initial presentation, 52 (88%) did not follow commands. Fifty-two (90%) patients with PTH had a VP shunt placed. Median time from injury to shunt placement was 69 (range, 9-366) days. Seven (12%) patients with PTH experienced postsurgical seizure, 3 (6%) had shunt infection, and 7 (12%) had shunt malfunction. Thirty-six (61%) patients with PTH emerged from PTA during rehabilitation. Median total FIM score at rehabilitation admission was 20 (range, 18-76), and at discharge it was 43 (range, 18-118). Injury severity predicted outcome at rehabilitation admission, whereas shunt timing predicted outcome at rehabilitation discharge. CONCLUSIONS Incidence of PTH was observed in 8% of patients with TBI in inpatient rehabilitation. Earlier shunting predicted improved outcome during rehabilitation. Future studies should prospectively examine clinical decision rules, type, and timing of intervention and the coeffectiveness of rehabilitation treatment on outcomes.
Collapse
|
8
|
Long-term Outcomes After Shunt Implantation in Patients With Posttraumatic Hydrocephalus and Severe Conscious Disturbance. J Craniofac Surg 2014; 25:1280-3. [DOI: 10.1097/scs.0000000000000583] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
9
|
Low CYD, Low YYS, Lee KK, Chan SP, Ang BT. Post-traumatic hydrocephalus after ventricular shunt placement in a Singaporean neurosurgical unit. J Clin Neurosci 2013; 20:867-72. [DOI: 10.1016/j.jocn.2012.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 06/02/2012] [Accepted: 06/06/2012] [Indexed: 10/27/2022]
|
10
|
CSF dynamics analysis in patients with post-traumatic ventriculomegaly. Clin Neurol Neurosurg 2013; 115:49-53. [DOI: 10.1016/j.clineuro.2012.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/02/2012] [Accepted: 04/22/2012] [Indexed: 11/23/2022]
|
11
|
Formisano R, Bivona U, Catani S, D'Ippolito M, Buzzi MG. Post-traumatic headache: facts and doubts. J Headache Pain 2009; 10:145-52. [PMID: 19294482 PMCID: PMC3451986 DOI: 10.1007/s10194-009-0108-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 02/03/2009] [Indexed: 11/26/2022] Open
Abstract
The International Classification of Headache Disorders does not separate the moderate from severe/very severe traumatic brain injury (TBI), since they are all defined by Glasgow coma scale (GCS) < 13. The distinction between the severe and very severe TBI (GCS < 8) should be made upon coma duration that in the latter may be longer than 15 days up to months in the case of vegetative state. Post-traumatic amnesia duration may double the coma duration itself. Therefore, the 3-month parameter proposed to define the occurrence or resolution of post-traumatic headache (PTH) appears inadequate. Following TBI, neuropathic pain, central pain, thalamic pain, combined pain are all possible and they call for proper pharmacological approaches. One more reason for having difficulties in obtaining information about headache in the early phase after regaining consciousness is the presence of concomitant medications that may affect pain perception. Post-traumatic stress disorder (PTSD) develops days or weeks after stress and tends to improve or disappear within 3 months after exposure; interestingly, this spontaneous timing resembles that of PTH. In our experience the number of TBI patients with PTH at 1-year follow-up is lower in those with longer coma duration and more severe TBI. Cognitive functioning evaluated after at least 12 months from TBI, showed mild or no impairment in these patients with severe TBI and PTH, whereas they have psychopathological changes, namely anxiety and depression. The majority of patients with PTH after severe/very severe TBI had skull fractures or dural lacerations and paroxystic EEG abnormalities. The combination of psychological changes (depression and anxiety) and organic features (skull fractures, dural lacerations, epileptic EEG abnormalities) in PTH may be inversely correlated with the severity of TBI, with prevalence of psychological disturbances in mild TBI and of organic lesions in severe TBI. On the other hand, only in severe TBI patients with good cognitive recovery the influence of the psychopathological disorders may play a role. In fact, the affective pain perception is probably related to the integrity of cognitive functions as in mild TBI and in severe TBI with good cognitive outcome.
Collapse
Affiliation(s)
- Rita Formisano
- Post-Coma Unit and Headache Center, IRCCS Fondazione Santa Lucia, Rome, Italy.
| | | | | | | | | |
Collapse
|
12
|
Wen L, Wan S, Zhan RY, Li G, Gong JB, Liu WG, Yang XF. Shunt implantation in a special sub-group of post-traumatic hydrocephalus--patients have normal intracranial pressure without clinical representations of hydrocephalus. Brain Inj 2009; 23:61-4. [PMID: 19172451 DOI: 10.1080/02699050802635265] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Post-traumatic hydrocephalus (PTH) is a frequent complication secondary to traumatic brain injury (TBI) and controversy remains over whether to perform a shunt placement for patients with normal pressure hydrocephalus when the patient is too injured to display symptoms or has atypical symptoms. METHOD A hospital-based retrospective study was performed in patients who developed normal pressure hydrocephalus, without atypical symptoms, from January 2004 to June 2007. Information regarding patients' demographics, TBI, hydrocephalus and outcome was collected. RESULTS A total of 31 patients were involved in this study. At the 12-month follow-up, 20 patients (64.5%) showed clear improvement. Among the 10 patients who developed PTH after decompressive craniectomy, cranioplasty was performed after shunt implantation and clinical improvement was observed in nine patients. Additionally, in this series, the patients' age and the severity of hydrocephalus, assessed by CT imaging before shunt placement, significantly correlated with improvement. CONCLUSION Although the effect was not definitively established, many patients in the sub-group of PTH patients described here would benefit from shunt placement, especially when they simultaneously have large cranial defects after surgical decompression and underwent cranioplasties after shunt placement. Additionally, younger patients and those with less severe hydrocephalus before shunt placement may expect a better outcome after shunt placement.
Collapse
Affiliation(s)
- L Wen
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, PR China
| | | | | | | | | | | | | |
Collapse
|