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Liu J, Zhang S, Chen Y, Jia X, Li Z, Li A, Zhang G, Jiang R. Cisternostomy is not beneficial to reduce the occurrence of post-traumatic hydrocephalus in Traumatic Brain Injury. Acta Neurochir (Wien) 2024; 166:200. [PMID: 38689141 DOI: 10.1007/s00701-024-06084-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The Cisternostomy is a novel surgical concept in the treatment of Traumatic Brain Injury (TBI), which can effectively drain the bloody cerebrospinal fluid from the skull base cistern, reduce the intracranial pressure, and improve the return of bone flap, but its preventive role in post-traumatic hydrocephalus (PTH) is unknow. The purpose of this paper is to investigate whether Cisternostomy prevents the occurrence of PTH in patients with moderate and severe TBI. METHODS A retrospective analysis of clinical data of 86 patients with moderate and severe TBI from May 2019 to October 2021 was carried out in the Brain Trauma Center of Tianjin Huanhu Hospital. Univariate analysis was performed to examine the gender, age, preoperative Glasgow Coma Scale (GCS) score, preoperative Rotterdam CT score, decompressive craniectomy rate, intracranial infection rate, the incidence of subdural fluid, and incidence of hydrocephalus in patients between the Cisternostomy group and the non-Cisternostomy surgery group. we also analyzed the clinical outcome indicators like GCS at discharge,6 month GOS-E and GOS-E ≥ 5 in two groups.Additionaly, the preoperative GCS score, decompressive craniectomy rate, age, and gender of patients with PTH and non hydrocephalus were compared. Further multifactorial logistic binary regression was performed to explore the risk factors for PTH. Finally, we conducted ROC curve analysis on the statistically significant results from the univariate regression analysis to predict the ability of each risk factor to cause PTH. RESULTS The Cisternostomy group had a lower bone flap removal rate(48.39% and 72.73%, p = 0.024)., higer GCS at discharge(11.13 ± 2.42 and 8.93 ± 3.31,p = 0.000) and better 6 month GOS-E(4.55 ± 1.26 and 3.95 ± 1.18, p = 0.029)than the non-Cisternostomy group However, there was no statistical difference in the incidence of hydrocephalus between the two groups (25.81% and 30.91%, p = 0.617). Moreover, between the hydrocephalus group and no hydrocephalus group,there were no significant differences in the incidence of gender, age, intracranial infection, and subdural fluid. While there were statistical differences in peroperative GCS score, Rotterdam CT score, decompressive craniectomy rate, intracranial infection rate, and the incidence of subdural fluid in the two groups, there was no statistical difference in the percentage of cerebral cisterns open drainage between the hydrocephalus group and no hydrocephalus group (32.00% and 37.70%, p = 0.617). Multifactorial logistic binary regression analysis results revealed that the independent risk factors for PTH were intracranial infection (OR = 18.460, 95% CI: 1.864-182.847 p = 0.013) and subdural effusion (OR = 10.557, 95% CI: 2.425-35.275 p = 0.001). Further, The ROC curve analysis showed that peroperative GCS score, Rotterdam CT score and subdural effusion had good ACU(0.785,0.730,and 0.749), with high sensitivity and specificity to predict the occurrence of PTH. CONCLUSIONS Cisternostomy may decrease morbidities associated with removal of the bone flap and improve the clinical outcome, despite it cannot reduce the disability rate in TBI patients.Intracranial infection and subdural fluid were found to be the independent risk factors for PTH in patients with TBI,and the peroperative GCS score, Rotterdam CT score and subdural effusion had higher sensitivity and specificity to predict the occurrence of PTH. And more importantly, no correlation was observed between open drainage of the cerebral cisterns and the occurrence of PTH, indicating that Cisternostomy may not be beneficial in preventing the occurrence of PTH in patients with moderate and severe TBI.
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Affiliation(s)
- Jun Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Shusheng Zhang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Yueda Chen
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Xiaoxiong Jia
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Zhongzhen Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Ailin Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Guobin Zhang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, 300350, China.
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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Beangklang R, Sitthinamsuwan B, Tansirisithikul C, Nunta-aree S. Hydrocephalus following Brain Tumor Surgery: Factors Correlating with Occurrence of Postoperative Hydrocephalus and Predictive Scoring Model. Asian J Neurosurg 2024; 19:44-51. [PMID: 38751388 PMCID: PMC11093642 DOI: 10.1055/s-0044-1779345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Hydrocephalus following brain tumor surgery is found, although cause of hydrocephalus is optimally eradicated. This study aimed to investigate factors associated with development of postoperative hydrocephalus that requires shunt procedure and generate predictive scoring model of this condition. Demographic, clinical, radiographic, treatment, laboratory, complication, and postoperative data were collected. Binary logistic regression was used to investigate final model for generating predictive scoring system of postoperative hydrocephalus. A total of 179 patients undergoing brain tumor surgery were included. Forty-five (25.1%) patients had postoperative hydrocephalus that required shunt surgery. In univariate analysis, several factors were found to be associated with postoperative hydrocephalus. Strong predictors of postoperative hydrocephalus revealed in multivariate analysis included tumor recurrence before surgery (odds ratio [OR], 4.38; 95% confidence interval [CI], 1.28-14.98; p = 0.018), preoperative hydrocephalus (OR, 6.52; 95% CI, 2.44-17.46; p < 0.001), glial tumor (OR, 3.76; 95% CI, 1.14-12.43; p = 0.030), metastasis (OR, 5.19; 95% CI, 1.72-15.69; p = 0.004), intraventricular hemorrhage (OR, 7.08; 95% CI, 1.80-27.82; p = 0.005), and residual tumor volume (OR, 1.05; 95% CI, 1.01-1.09; p = 0.007). A cutoff predictive score with the best area under curve and optimum cutoff point was utilized for discriminating patients with high risk from individuals with low risk in occurrence of postoperative hydrocephalus. This study reported predictive factors strongly associated with development of postoperative hydrocephalus. Predictive scoring system is useful for identifying patients with an increased risk of postoperative hydrocephalus. Patients classified in the high-risk group require closed surveillance of the hydrocephalus.
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Affiliation(s)
- Raweenut Beangklang
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Surgery, Buriram Hospital, Buriram, Thailand
| | - Bunpot Sitthinamsuwan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chottiwat Tansirisithikul
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sarun Nunta-aree
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ran KR, Vattipally VN, Giwa GA, Myneni S, Raj D, Dardick JM, Rincon-Torroella J, Ye X, Byrne JP, Suarez JI, Lin SC, Jackson CM, Mukherjee D, Gallia GL, Huang J, Weingart JD, Azad TD, Bettegowda C. Craniotomy versus craniectomy for traumatic acute subdural hematoma-coarsened exact matched analysis of outcomes. J Clin Neurosci 2024; 119:52-58. [PMID: 37984187 DOI: 10.1016/j.jocn.2023.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/17/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Acute subdural hematoma (aSDH) after traumatic brain injury frequently requires emergent craniotomy (CO) or decompressive craniectomy (DC). We sought to determine the variables associated with either surgical approach and to compare outcomes between matched patients. METHODS A multi-center retrospective review was used to identify traumatic aSDH patients who underwent CO or DC. Patient variables independently associated with surgical approach were used for coarsened exact matching.Multivariate logistic regression and multivariate Cox proportional-hazards regression wereconducted on matched patients to determine independent predictors of mortality. RESULTS Seventy-six patients underwent CO and sixty-two underwent DC for aSDH evacuation. DC patients were21.4 years younger (P < 0.001), more likely to be male (80.6 % vs 60.5 %,P = 0.011), and present with GCS ≤ 8 (64.5 % vs 36.8 %,P = 0.001). Age (P < 0.001), epidural hematoma (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and intraventricular hemorrhage (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003). CONCLUSION aSDH patients who receive surgical evacuation via DC as opposed to CO are younger, more likely to be male, and have worse clinical exam. After controlling for patient differences via coarsened exact matching, DC is independently associated with mortality.
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Affiliation(s)
- Kathleen R Ran
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Vikas N Vattipally
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ganiat A Giwa
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Saket Myneni
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Divyaansh Raj
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph M Dardick
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James P Byrne
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jose I Suarez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shih-Chun Lin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jon D Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Chen TN, Kuo KL, Lin CL, Su YF. Middle Cerebral Artery Compromise Associated With Post-traumatic Hydrocephalus: A Case Report. Korean J Neurotrauma 2023; 19:466-470. [PMID: 38222833 PMCID: PMC10782109 DOI: 10.13004/kjnt.2023.19.e57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/13/2023] [Accepted: 09/22/2023] [Indexed: 01/16/2024] Open
Abstract
Post-traumatic hydrocephalus (PTH) is a commonly encountered complication following decompressive craniectomy, and is usually characterized by symptoms including headache, nausea, vomiting, and papilledema. Extracranial herniation accompanied by hemiplegia is a rare complication in patients with PTH who underwent craniectomy after subdural hematoma removal. We report a case of PTH that presented with extracranial herniation within one month of decompressive craniectomy. Following ventriculoperitoneal shunt implantation, left hemiplegia improved dramatically with restoration of the left middle cerebral artery blood flow, which was evident on serial imaging. Vascular compromise is often overshadowed by increased intracranial pressure when clinicians are dealing with traumatic brain injury patients. Delicate neurological and radiological examinations and prompt early interventions could lead to optimal outcomes in patients receiving decompressive craniectomy.
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Affiliation(s)
- Tzu-Ning Chen
- Department of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Keng-Liang Kuo
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Lung Lin
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Feng Su
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Sanker V, Kundu M, El Kassem S, El Nouiri A, Emara M, Maaz ZA, Nazir A, Bekele BK, Uwishema O. Posttraumatic hydrocephalus: Recent advances and new therapeutic strategies. Health Sci Rep 2023; 6:e1713. [PMID: 38028696 PMCID: PMC10652704 DOI: 10.1002/hsr2.1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hydrocephalus or ventriculomegaly is a condition brought on by an overabundance of cerebrospinal fluid (CSF) in the ventricular system. The major contributor to posttraumatic hydrocephalus (PTH) is traumatic brain injuries (TBIs), especially in individuals with occupations set in industrial settings. A variety of criteria have been employed for the diagnosis of PTH, including the combination of neurological symptoms like nerve deficits and headache, as well as an initial improvement followed by a worsened relapse of altered consciousness and neurological deterioration, which is detected by computed tomography-brain imaging that reveals gradual ventriculomegaly. Aim In this article, we discuss and summarize briefly the current understandings and advancements in the management of PTH. Methods The available literature for this review was searched on various bibliographic databases using an individually verified, prespecified approach. The level of evidence of the included studies was considered as per the Centre for Evidence-Based Medicine recommendations. Results The commonly practiced current treatment modality involves shunting CSF but is often associated with complications and recurrence. The lack of a definitive management strategy for PTH warrants the utilization of novel and innovative modalities such as stem cell transplantations and antioxidative stress therapies. Conclusion One of the worst complications of a TBI is PTH, which has a high morbidity and mortality rate. Even though there hasn't been a successful method in stopping PTH from happening, hemorrhage-derived blood, and its metabolic by-products, like iron, hemoglobin, free radicals, thrombin, and red blood cells, may be potential targets for PTH hindrance and management. Also, using stem cell transplantations in animal models and antioxidative stress therapies in future studies can lower PTH occurrence and improve its outcome. Moreover, the integration of clinical trials and theoretical knowledge should be encouraged in future research projects to establish effective and updated management guidelines for PTH.
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Affiliation(s)
- Vivek Sanker
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Society of Brain Mapping and TherapeuticsLos AngelesCaliforniaUSA
| | - Mrinmoy Kundu
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Institute of Medical Sciences and SUM HospitalBhubaneswarIndia
| | - Sarah El Kassem
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Ahmad El Nouiri
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Mohamed Emara
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- College of MedicineUniversity of SharjahSharjahUnited Arab Emirates
| | - Zeina Al Maaz
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Abubakar Nazir
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
| | - Bezawit Kassahun Bekele
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- School of MedicineAddis Ababa UniversityAddis AbabaEthiopia
- Milken Institute of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Olivier Uwishema
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of medicineClinton Global Initiative UniversityNew YorkNew YorkUSA
- Faculty of MedicineKaradeniz Technical UniversityTrabzonTurkey
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Xu H, Dong Y, Bao D, Wei X, Niu C, Liu X. Shunt-Dependent Post-Traumatic Hydrocephalus: Predictors and Long-Term Functional Outcomes. Neurol Ther 2023; 12:1607-1622. [PMID: 37330939 PMCID: PMC10444705 DOI: 10.1007/s40120-023-00511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION As a disorder of the brain in adults and children, traumatic brain injury (TBI) is considered the major cause of mortality and morbidity. As a serious complication of TBI, post-traumatic hydrocephalus (PTH) is commonly identified and significantly associated with neurocognitive impairment, motor dysfunction, and growth impairment. The long-term functional outcomes after shunt dependence are totally not clear. METHODS This study included 6279 patients between 2012 and 2022. To identify the unfavorable functional outcomes and the PTH-related factors, we carried out univariable logistic regression analyses. To identify the occurrence time of PTH, we conducted the log-rank test and Kaplan-Meier analysis. RESULTS Mean patient age was 51.03 ± 22.09 years. Of the 6279 patients with TBI, 327 developed PTH (5.2%). Several PTH development-associated factors, such as intracerebral hematoma, diabetes, longer initial hospital stay, craniotomy, low GCS (Glasgow Coma Scale), EVD (external ventricular drain), and DC (decompressive craniectomy) (p < 0.01), were identified. We also analyzed the factors of unfavorable outcomes after TBI including > 80 years, repeated operations, hypertension, EVD, tracheotomy, and epilepsy (p < 0.01). Ventriculoperitoneal shunt (VPS) itself is not an independent factor of the unfavorable outcome but shunt complication is a strong independent factor of unfavorable outcome (p < 0.05). CONCLUSION We should emphasize the practices that can minimize the risks of shunt complications. Additionally, the rigorous radiographic and clinical surveillance will benefit those patients at high risk of developing PTH. TRIAL REGISTRATION ClinicalTrials.gov identifier, ChiCTR2300070016.
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Affiliation(s)
- Hao Xu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001 Anhui China
| | - Yongfei Dong
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001 Anhui China
| | - Dejun Bao
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001 Anhui China
| | - Xiangpin Wei
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001 Anhui China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001 Anhui China
| | - Xinfeng Liu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001 Anhui China
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Ultrasonography for Serial Monitoring and Management of Cerebrospinal Fluid Dynamic Disorders After Decompressive Craniectomy. J Craniofac Surg 2022; 33:2400-2405. [PMID: 35894445 PMCID: PMC9612685 DOI: 10.1097/scs.0000000000008785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022] Open
Abstract
Decompressive craniectomy (DC) is widely used to treat intracranial hypertension following severe head injury. However, impairments of cerebrospinal fluid (CSF) hydrodynamics such as hydrocephalus and subdural effusion are common complications that occur after DC. Therefore, monitoring of intracranial pressure is a staple of neurocritical care post-DC. The aim of this study was to assess the usefulness of transcranial duplex sonography (TDS) for serial monitoring and management of CSF disorders after DC.
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Prediction of adult post-hemorrhagic hydrocephalus: a risk score based on clinical data. Sci Rep 2022; 12:12213. [PMID: 35842469 PMCID: PMC9288433 DOI: 10.1038/s41598-022-16577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022] Open
Abstract
There is lacking research on risk factors and prediction models associated with Post-hemorrhagic hydrocephalus (PHH). Thus, this present study aimed to analyze the risk factors of PHH and establish a risk-scoring system through a large-scale study. A retrospective study of 382 patients with intracranial hemorrhage assessed age, history and diagnosis, Glasgow coma score (GCS), and fever time. After univariate and logistic regression analysis, a risk scoring system was established according to independent risk factors and evaluated using the area under the curve (AUC). Of the 382 patients, 133 (34.8%) had PHH, 43 (11.3%) received surgical treatment. Factor classification showed that age > 60 years old [odds ratio (OR): 0.347, II = 5 points], GCS < 5 (OR: 0.09, IV = 10 points), GCS 6‒8 (OR = 0.232, III = 6 points), fever time > 9 (OR: 0.202, III = 7 points), fever time 5-9 (OR: 0.341, II = 5 points), CSF-TP x time > 14,4000 group (OR: 0.267, IV = 6 points), and CSF-TP x time 9,601‒14,400 group (OR: 0.502, III = 3 points) were independent risk factors. The result of the receiver operating characteristic (ROC) prediction showed that AUC = 0.790 (0.744‒0.836). Low-risk (IV-VII), moderate (VIII-X), and high-risk group (XI-XIII) incidence of PHH were 11.76%, 50.55%, and 70.00% (p < 0.001), respectively. The coincidence rates in the validation cohort were 26.00%, 74.07%, and 100.0% (p < 0.001), respectively. AUC value was 0.860 (0.780‒0.941). The predictive model was conducive to determining the occurrence of PHH and facilitating early intervention.
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Bedside Ultrasound for Ventricular Size Monitoring in Patients with PEEK Cranioplasty: A Preliminary Experience of Technical Feasibility in Neurotrauma Setting. Neurocrit Care 2022; 37:705-713. [PMID: 35761126 DOI: 10.1007/s12028-022-01544-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/01/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Posttraumatic hydrocephalus is a known complication after traumatic brain injury, particularly affecting patients undergoing decompressive craniectomy. Posttraumatic hydrocephalus monitoring in these patients represents a common issue in neurosurgical practice. Patients require periodical assessments by means of computed tomography (CT) scans. This study presents a preliminary institutional series in which ultrasound was used as a bedside imaging technique to monitor ventricular size in patients harboring a polyetheretherketone (PEEK) cranioplasty. Exploiting the PEEK cranioplasty permeability to echoes, we evaluated the feasibility of this bedside imaging method in monitoring hydrocephalus evolution, determining effects of ventriculo-peritoneal shunt, and excluding complications. METHODS Eight patients with traumatic brain injury harboring PEEK cranioplasty following decompressive craniectomy were prospectively evaluated. Ultrasound measurements were compared with CT scan data taken the same day, and ventricular morphometry parameters were compared. RESULTS Ultrasound images through the PEEK cranioplasty were of high quality and intracranial anatomy was distinctly evaluated. A strong correlation was observed between ultrasound and CT measurements. Concerning distance between lateral ventricles frontal horns (IFH) and the diameter of the third ventricle (TV), we found a strong correlation between transcranial sonography and CT measurements in preventriculoperitoneal shunt (rho = 0.92 and p = 0.01 for IFH; rho = 0.99 and p = 0.008 for TV) and in postventriculoperitoneal shunt examinations (rho = 0.95 and p = 0.03 for IFH; rho = 0.97 and p = 0.03 for TV). The mean error rate between transcranial sonography and CT scan was 1.77 ± 0.91 mm for preoperative IFH, 0.65 ± 0.27 mm for preoperative TV, 2.18 ± 0.82 mm for postoperative IFH, and 0.48 ± 0.21 mm for postoperative TV. CONCLUSIONS Transcranial ultrasound could represent a simplification of the follow-up and management of ventricular size of patients undergoing PEEK cranioplasty. Even if this is a small series, our preliminary results could widen the potential benefits of PEEK, not only as effective material for cranial reconstruction but also, in selected clinical conditions, as a reliable window to explore intracranial content and to monitor ventricular sizes and shunt functioning.
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Complications of Cranioplasty Following Decompressive Craniectomy: Risk Factors of Complications and Comparison Between Autogenous and Artificial Bones. Korean J Neurotrauma 2022; 18:238-245. [DOI: 10.13004/kjnt.2022.18.e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
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Sam JE, Kandasamy R, Wong ASH, Ghani ARI, Ang SY, Idris Z, Abdullah JM. Vacuum Drains versus Passive Drains versus No Drains in Decompressive Craniectomies-A Randomized Controlled Trial on Subgaleal Drain Complication Rates (VADER Trial). World Neurosurg 2021; 156:e381-e391. [PMID: 34563715 DOI: 10.1016/j.wneu.2021.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Subgaleal drains are generally deemed necessary for cranial surgeries including decompressive craniectomies (DCs) to avoid excessive postoperative subgaleal hematoma (SGH) formation. Many surgeries have moved away from routine prophylactic drainage but the role of subgaleal drainage in cranial surgeries has not been addressed. METHODS This was a randomized controlled trial at 2 centers. A total of 78 patients requiring DC were randomized in a 1:1:1 ratio into 3 groups: vacuum drains (VD), passive drains (PD), and no drains (ND). Complications studied were need for surgical revision, SGH amount, new remote hematomas, postcraniectomy hydrocephalus (PCH), functional outcomes, and mortality. RESULTS Only 1 VD patient required surgical revision to evacuate SGH. There was no difference in SGH thickness and volume among the 3 drain types (P = 0.171 and P = 0.320, respectively). Rate of new remote hematoma and PCH was not significantly different (P = 0.647 and P = 0.083, respectively), but the ND group did not have any patient with PCH. In the subgroup analysis of 49 patients with traumatic brain injury, the SGH amount of the PD and ND group was significantly higher than that of the VD group. However, these higher amounts did not translate as a significant risk factor for poor functional outcome or mortality. VD may have better functional outcome and mortality. CONCLUSIONS In terms of complication rates, VD, PD, and ND may be used safely in DC. A higher amount of SGH was not associated with poorer outcomes. Further studies are needed to clarify the advantage of VD regarding functional outcome and mortality, and if ND reduces PCH rates.
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Affiliation(s)
- Jo Ee Sam
- Department of Neurosciences, School of Medical Sciences, Jalan Hospital USM, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia; Department of Neurosurgery, Hospital Umum Sarawak, Jalan Hospital, Sarawak, Malaysia.
| | - Regunath Kandasamy
- Department of Neurosciences, School of Medical Sciences, Jalan Hospital USM, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia
| | - Albert Sii Hieng Wong
- Department of Neurosurgery, Hospital Umum Sarawak, Jalan Hospital, Sarawak, Malaysia
| | - Abdul Rahman Izaini Ghani
- Department of Neurosciences, School of Medical Sciences, Jalan Hospital USM, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia
| | - Song Yee Ang
- Department of Neurosciences, School of Medical Sciences, Jalan Hospital USM, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Jalan Hospital USM, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences & Brain Behaviour Cluster, Hospital Universiti Sains, Malaysia, Universiti Sains Malaysia, Health Campus, Kota Bharu, Kelantan, Malaysia
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12
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Hannah EM, Zyck S, Hazama A, Krishnamurthy S. Scoping review of the risk factors and time frame for development of post-traumatic hydrocephalus. Rev Neurosci 2021; 33:133-146. [PMID: 34144640 DOI: 10.1515/revneuro-2021-0043] [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] [Received: 03/17/2021] [Accepted: 05/21/2021] [Indexed: 11/15/2022]
Abstract
Post-traumatic hydrocephalus (PTH) following traumatic brain injury (TBI) may develop within or beyond the acute phase of recovery. Recognition and subsequent treatment of this condition leads to improved neurologic outcomes. In this scoping review, we identify statistically significant demographic, clinical, radiographic, and surgical risk factors as well as a predictive time frame for the onset of PTH in order to facilitate timely diagnosis. Two researchers independently performed a scoping review of the PubMed and Cochrane databases for articles relevant to risk factors for PTH. Articles that met inclusion and exclusion criteria underwent qualitative analysis. Twenty-seven articles were reviewed for statistically significant risk factors and a proposed time frame for the onset of PTH. Variables that could serve as proxies for severe brain injuries were identified as risk factors. The most commonly identified risk factors included either very young or old age, intracranial hemorrhage including intraventricular hemorrhage, hygroma, and need for decompressive craniectomy. Although the timeframe for diagnosis of PTH varied widely from within one week to 31.5 months after injury, the first 50 days were more likely. Established risk factors and timeframe for PTH development may assist clinicians in the early diagnosis of PTH after TBI. Increased consistency in diagnostic criterion and reporting of PTH may improve recognition with early treatment of this condition in order to improve outcomes.
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Affiliation(s)
- Emily M Hannah
- Department of Biological Sciences, The George Washington University, Washington, DC20052, USA
| | - Stephanie Zyck
- Department of Neurosurgery, Upstate Medical University, Syracuse, NY13210, USA
| | - Ali Hazama
- Department of Neurosurgery, Upstate Medical University, Syracuse, NY13210, USA
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13
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Williams JR, Meyer MR, Ricard JA, Sen R, Young CC, Feroze AH, Greil ME, Barros G, Durfy S, Hanak B, Morton RP, Temkin NR, Barber JK, Mac Donald CL, Chesnut RM. Re-examining decompressive craniectomy medial margin distance from midline as a metric for calculating the risk of post-traumatic hydrocephalus. J Clin Neurosci 2021; 87:125-131. [PMID: 33863519 DOI: 10.1016/j.jocn.2021.02.025] [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] [Received: 07/27/2020] [Revised: 12/14/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Decompressive craniectomy (DC) is a life-saving procedure in severe traumatic brain injury, but is associated with higher rates of post-traumatic hydrocephalus (PTH). The relationship between the medial craniectomy margin's proximity to midline and frequency of developing PTH is controversial. The primary study objective was to determine whether average medial craniectomy margin distance from midline was closer to midline in patients who developed PTH after DC for severe TBI compared to patients that did not. The secondary objective was to determine if a threshold distance from midline could be identified, at which the risk of developing PTH increased if the DC was performed closer to midline than this threshold. A retrospective review was performed of 380 patients undergoing DC at a single institution between March 2004 and November 2014. Clinical, operative and demographic variables were collected, including age, sex, DC parameters and occurrence of PTH. Statistical analysis compared mean axial craniectomy margin distance from midline in patients with versus without PTH. Distances from midline were tested as potential thresholds. No significant difference was identified in mean axial craniectomy margin distance from midline in patients developing PTH compared with patients with no PTH (n = 24, 12.8 mm versus n = 356, 16.6 mm respectively, p = 0.086). No significant cutoff distance from midline was identified (n = 212, p = 0.201). This study, the largest to date, was unable to identify a threshold with sufficient discrimination to support clinical recommendations in terms of DC margins with regard to midline, including thresholds reportedly significant in previously published research.
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Affiliation(s)
- John R Williams
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA.
| | - Michael R Meyer
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Jocelyn A Ricard
- University of Minnesota, 3 Morrill Hall, 100 Church St. S.E, Minneapolis, MN 55455, USA
| | - Rajeev Sen
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Christopher C Young
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Abdullah H Feroze
- Department of Neurosurgery, Loma Linda University Health, 11234 Anderson St., Suite 2562B, Loma Linda, CA 92354, USA
| | - Madeline E Greil
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Guilherme Barros
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Brian Hanak
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Ryan P Morton
- Department of Neurosurgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7843, San Antonio, TX 78229, USA
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Jason K Barber
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Christine L Mac Donald
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
| | - Randall M Chesnut
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA
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DiRisio AC, Stopa BM, Pompeu YA, Vasudeva V, Khawaja AM, Izzy S, Gormley WB. Extra-Axial Fluid Collections After Decompressive Craniectomy: Management, Outcomes, and Treatment Algorithm. World Neurosurg 2021; 149:e188-e196. [PMID: 33639283 DOI: 10.1016/j.wneu.2021.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extra-axial fluid collections (EACs) frequently develop after decompressive craniectomy. Management of EACs remains poorly understood, and information on how to predict their clinical course is inadequate. We aimed to better characterize EACs, understand predictors of their resolution, and delineate the best treatment paradigm for patients. METHODS We reviewed patients who developed EACs after undergoing decompressive craniectomy for treatment of refractory intracranial pressure elevations. We excluded patients who had an ischemic stroke, as EACs in these patients have a different clinical course. We performed univariate analysis and multiple linear regression to find variables associated with earlier resolution of EACs and stratified our analyses by EAC phenotype (complicated vs. uncomplicated). We conducted a systematic review to compare our findings with the literature. RESULTS Of 96 included patients, 73% were male, and median age was 42.5 years. EACs resolved after a median of 60 days. Complicated EACs were common (62.5%) and required multiple drainage methods before cranioplasty. These were not associated with a protracted course or increased risk of death (P > 0.05). Early bone flap restoration with simultaneous drainage was independently associated with earlier resolution of EACs (β = 0.56, P < 0.001). Systematic review confirmed lack of standardized direction with respect to EAC management. CONCLUSIONS Our analyses reveal 2 clinically relevant phenotypes of EAC: complicated and uncomplicated. Our proposed treatment algorithm involves replacing the bone flap as soon as it is safe to do so and draining refractory EACs aggressively. Further studies to assess long-term clinical outcomes of EACs are warranted.
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Affiliation(s)
- Aislyn C DiRisio
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA; Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Brittany M Stopa
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Yuri A Pompeu
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA; Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA
| | - Viren Vasudeva
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayaz M Khawaja
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Saef Izzy
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William B Gormley
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
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15
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Mahapatra A. Hydrocephalus Research. Neurol India 2021; 69:S264-S267. [DOI: 10.4103/0028-3886.332258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Mavrovounis G, Kalogeras A, Brotis A, Iaccarino C, Demetriades AK, Fountas KN. 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 AND SPINE 2021; 1:100303. [PMID: 36247396 PMCID: PMC9560681 DOI: 10.1016/j.bas.2021.100303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Abstract
Introduction There is an ongoing debate whether Decompressive Craniectomy (DC) serves as an independent risk factor for the development of Post-traumatic Hydrocephalus (PTH). Research question The aim of this systematic review and meta-analysis was to compare the incidence of PTH in TBI patients that underwent DC versus those that were managed without DC. Materials and methods The literature was systematically reviewed to identify studies with specific inclusion criteria: (1) Randomized Controlled Trials and observational studies with more than 10 patients in each study arm, (2) comparing the incidence of PTH, (3) in patients aged ≥15 years old, (4) that either underwent DC or received other treatment (non-DC). (5) Only studies in English were included and (6) no restrictions were applied on publication date. The pooled Odds Ratio (OR) and Confidence Interval (CI) were calculated. The quality of the included studies was assessed using the ROBINS and RoB 2.0 tools. Results Evidence from six articles was synthesized, incorporating data from 2522 patients. A statistically significant higher occurrence of PTH [OR (95% CI): 4.84 (2.51, 9.31); Pz < 0.00001] was identified in patients undergoing DC for TBI when compared to those that were managed without DC. The same was true when only patients with severe TBI were included in the analysis [OR (95% CI): 2.87 (1.85, 4.43); Pz < 0.00001]. Discussion and conclusion Our study has shown, within limitations, a clear association between DC and PTH. Further prospective studies, providing high-quality evidence, are needed to definitively establish any causative relationship between DC and PTH. TBIs are associated with the development of PTH. Patients undergoing decompressive craniectomy are more likely to develop PTH. Further studies should be conducted to establish a causative relationship.
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17
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Vemula RCV, Prasad BC, Kumar K. Retrospective Analytic Study of Neurosurgical Patients Who Developed Postoperative Hydrocephalus. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1717219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Objective This article discusses the causes, primary pathologies, management, and prognosis of patients who did not have hydrocephalus in preoperative stage, underwent definitive surgical procedure, and developed postoperative hydrocephalus requiring cerebrospinal fluid (CSF) diversion procedures.
Methods Retrospective data collection was done from operation theatre (OT) department database and patient records were obtained for the patients after, related literature was searched, all possible risk factors were analyzed, and our results were compared with other studies.
Results A total of 80 cases were found eligible for the study. Decompressive craniectomy was the most common cause followed by aneurysmal subarachnoid hemorrhage (SAH), intraventricular, and cerebellopontine angle (CPA) tumors. Rate of postsurgical hydrocephalus was 15 to 16%. Cases of decompressive craniectomy presented late, only few cases required diversion procedures during the immediate postop period, mostly aneurysm cases and tumors bed bleed. Out of total 6 mortalities, none of them were directly attributable to hydrocephalus. Since most patient presented after initial stabilization, permanent ventriculoperitoneal shunting was found to be the best option.
Conclusion Cases of decompression surgery should be under vigilant follow-up after discharge and even after cranioplasty for risk of development of hydrocephalus and requirement of permanent shunting. Cases with intraventricular hemorrhage or SAH should be considered as future candidate with risk of developing hydrocephalus. Lamina terminalis opening whenever possible results in favorable outcome in cases of anterior circulation aneurysms. CSF protein analysis in cases of intraventricular and CPA tumors should be done whenever possible, preferably routinely.
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Affiliation(s)
| | - B. C.M. Prasad
- Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India
| | - Kunal Kumar
- Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India
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Kim JH, Ahn JH, Oh JK, Song JH, Park SW, Chang IB. Factors associated with the development and outcome of hydrocephalus after decompressive craniectomy for traumatic brain injury. Neurosurg Rev 2020; 44:471-478. [PMID: 31953782 DOI: 10.1007/s10143-019-01179-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 07/29/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
Posttraumatic hydrocephalus (PTH) is common in patients undergoing decompressive craniectomy (DC) for traumatic brain injury (TBI), but the incidence, mechanisms, and risk factors have not been fully elucidated. This study aimed to determine the incidence of and the factors associated with PTH. We retrospectively reviewed patients who underwent DC for TBI at our institute between January 2014 and December 2018. We identified and compared the demographic, clinical, and radiological data, and 12-month functional outcome (as assessed by the Glasgow Outcome Scale [GOS]) between patients who developed PTH and those who did not. Logistic regression analyses were performed to identify risk factors for PTH. Additionally, the influence of PTH on unfavorable functional outcome was analyzed. PTH developed in 18 (18.95%) of the 95 patients who survived at 1 month after DC. A multivariate analysis indicated that postoperative intraventricular hemorrhage (odds ratio [OR] 4.493, P = 0.020), postoperative subdural hygroma (OR 4.074, P = 0.021), and postoperative hypothermia treatment (OR 9.705, P = 0.010) were significantly associated with PTH. The 12-month functional outcome significantly differed between the patients who developed PTH and those who did not (P = 0.049). Patients who developed PTH had significantly poorer 12-month functional outcomes than those who did not (P = 0.049). Another multivariate analysis indicated that subdural hemorrhage (OR 6.814, P = 0.031) and the presence of at least one dilated pupil before DC (OR 8.202, P = 0.000) were significantly associated with unfavorable functional outcomes (GOS grades 1-3). Although the influence of PTH (OR 5.122, P = 0.056) was not statistically significant in the multivariate analysis, it had a great impact on unfavorable functional outcomes. PTH considerably affects functional outcomes at 12 months after DC for TBI. Furthermore, postoperative imaging findings such as intraventricular hemorrhage and subdural hygroma can predict the development of PTH; therefore, careful observation is required during the follow-up period.
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Affiliation(s)
- Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro, Dongan-gu, Anyang-si, 14068, Gyeonggi-do, Republic of Korea
| | - Jun Hyong Ahn
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro, Dongan-gu, Anyang-si, 14068, Gyeonggi-do, Republic of Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro, Dongan-gu, Anyang-si, 14068, Gyeonggi-do, Republic of Korea
| | - Joon Ho Song
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro, Dongan-gu, Anyang-si, 14068, Gyeonggi-do, Republic of Korea
| | - Seung Woo Park
- Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - In Bok Chang
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro, Dongan-gu, Anyang-si, 14068, Gyeonggi-do, Republic of Korea.
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Schmidt BT, Cikla U, Kozan A, Dempsey RJ, Baskaya MK. Hydrocephalus Following Giant Transosseous Vertex Meningioma Resection. J Neurol Surg B Skull Base 2019; 82:370-377. [PMID: 34026415 DOI: 10.1055/s-0039-3400221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022] Open
Abstract
Introduction Meningiomas are among the most common primary intracranial tumors. While well-described, there is limited information on the outcomes and consequences following treatment of giant-sized vertex-based meningiomas. These meningiomas have specific risks and potential complications due to their size, location, and involvement with extracalvarial soft tissue and dural sinuses. Herein, we present four giant-sized vertex transosseous meningioma cases with involvement and occlusion of the sagittal sinus, that postoperatively developed external hydrocephalus and ultimately required shunting. Methods A retrospective chart review identified patients with large vertex meningiomas that were: (1) large (>6 cm) with hemispheric (no skull base) location, (2) involvement of the superior sagittal sinus resulting in complete sinus occlusion, (3) involvement of dura resulting in a large duraplasty area, (4) transosseous involvement requiring a 5 cm or larger craniectomy for resection of invaded calvarial bone. Results Tumors were resected in all four cases, with all patients subsequently developing external hydrocephalus which required shunting within 2 weeks to 6 months postsurgery. Conclusion We believe this may be the first report of the development of hydrocephalus following surgical resection of these large lesions. Based on our observations, we propose that a combination of superior sagittal sinus occlusion and changes in brain elasticity and compliance affect the brain's CSF absorptive capacity, which ultimately lead to hydrocephalus development. We suggest that neurosurgeons be aware that postoperative hydrocephalus can quickly develop following treatment of giant-sized vertex-based meningiomas, and that correction of hydrocephalus with shunting can readily be achieved.
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Affiliation(s)
- Bradley T Schmidt
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
| | - Ulas Cikla
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
| | - Abdulbaki Kozan
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
| | - Mustafa K Baskaya
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
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Hoffman H, Furst T, Jalal MS, Chin LS. Costs and predictors of 30-day readmissions after craniotomy for traumatic brain injury: a nationwide analysis. J Neurosurg 2019; 133:875-883. [PMID: 31398707 DOI: 10.3171/2019.5.jns19459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is increasing interest in the use of 30-day readmission (30dRA) as a quality metric to represent hospital and provider performance. Data regarding the incidence and risk factors for 30dRA after traumatic brain injury (TBI) are sparse. The authors sought to characterize these variables using a national database. METHODS The Nationwide Readmissions Database was used to identify patients with a primary diagnosis of TBI who underwent craniotomy or craniectomy between 2010 and 2014. Our primary outcome of interest was 30dRA. Binary logistic regression was used to identify variables related to patient demographics, comorbidities, and index hospital admission that were associated with 30dRA. RESULTS A total of 25,354 patients met the inclusion criteria. The 30dRA rate during the entire study period was 15.5%. In 2010 the 30dRA rate was 16.8% and in 2014 it decreased to 15.1% (pooled OR 0.90, 95% CI 0.87-0.94). The mean cost associated with a 30dRA increased slightly but significantly, from $9999 in 2010 to $10,114 in 2014 (p = 0.021). Factors associated with increased odds of 30dRA in the binary logistic regression included increased age, greater comorbidity burden, more severe injury, tracheostomy, gastrostomy, sodium abnormality, and venous thromboembolism. In order of decreasing frequency, the most common causes for 30dRA were neurological, injury/iatrogenic, cardiovascular/cerebrovascular, infectious, and respiratory. CONCLUSIONS The incidence of 30dRA after craniotomy for TBI decreased slightly from 2010 to 2014. This study identified several variables associated with 30dRA that require confirmation in a prospective study, which could direct attempts to prevent readmissions.
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21
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Silva Neto AR, Valença MM. Transcalvarial brain herniation volume as a predictor of posttraumatic hydrocephalus after decompressive craniectomy. Clin Neurol Neurosurg 2019; 182:73-78. [PMID: 31096109 DOI: 10.1016/j.clineuro.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In patients undergoing decompressive craniectomy for traumatic brain injury(TBI) there has been reported an incidence of hydrocephalus between 0-45%. There are several radiological and clinical features described in association with development of hydrocephalus. For study the influence of these factors we conducted a retrospective observational single-center cohort study in a tertiary care center with special attention to the transcalvarial herniation(TCH) volume after decompressive craniectomy. PATIENTS AND METHODS We selected 50 patients that underwent decompressive craniectomy after closed head injury between january 2014 and January 2015. Hydrocephalus was defined as a modified frontal horn index greater than 33%, presence of Gudeman CT scan criteria or insertion of ventriculoperitoneal Shunt. Variables analyzed were: age, post-resuscitation Glasgow coma scale (GCS) score, pupil reactivity, Zunkeller index, presence of hygroma, TCH volume, craniectomy diameter and distance of craniectomy from midline. Logistic regression was used with hydrocephalus as the primary outcome measure. RESULTS 17 patients developed hydrocephalus (34%). TCH volume after decompression(p < 0.01), subdural hygroma (p < 0.01), lower admission Glasgow Coma Scale score (p = 0.015), unilateral pupil reactivity(p = 0.042) and higher Zumkeller index(p = 0.044) were significant risk factors for hydrocephalus. Logistic regression analysis showed that factors independently associated with the development of hydrocephalus was the TCH volume (odds ratio 11.08; 95%CI 2.10, 58.4; p = 0.0046), and presence of hygroma (odds ratio 49.59; 95%IC 4.1, 459; p = 0.002). CONCLUSIONS There was a clear association between severity of TBI, TCH volume and subdural hygroma with the development of hydrocephalus. Clinicians should follow closely patients with those findings in order to avoid late deterioration.
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Affiliation(s)
- Angelo R Silva Neto
- Department of Neuropsychiatry, Federal University of Pernambuco, Recife, Brazil; Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Brazil.
| | - Marcelo M Valença
- Department of Neuropsychiatry, Federal University of Pernambuco, Recife, Brazil
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Mikami T, Suzuki H, Ukai R, Kimura Y, Miyata K, Akiyama Y, Wanibuchi M, Mikuni N. Flattening the curvature of synthetic materials to relieve scalp skin tension in cranioplasty. J Clin Neurosci 2018; 61:196-200. [PMID: 30420204 DOI: 10.1016/j.jocn.2018.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Scalp tissue shrinkage and volume contraction is a major problem in cranioplasty, and sometimes a tissue expander must be set before cranioplasty. The procedure for placing scalp expanders is cumbersome. In this study, we present a method for flattening the curvature of synthetic materials to relieve scalp skin tension and discuss the feasibility and limitations of the method. METHODS A total of 25 cranioplasty patients were included in this study. The optimal degree of curvature flattening for each piece of bone substitute material was determined based on cosmetic considerations and the extent of encephalomalacia or atrophy due to primary disease. In this series, the correlation between the degree of curvature flattening and the size or location of the bone flap was considered, and the amount of scalp surface area that could be obtained through curvature flattening was estimated. RESULTS The median degree of curvature flattening was 5.0 mm. The degree of curvature flattening showed moderate correlation with the rate of change in the area of synthetic material achieved through curvature flattening (p < 0.001). The 21 cases of fronto-temporal craniectomy were divided into two groups according to the distance from the midline. There was a statistically significant difference between these two groups in degree of flattening curvature. CONCLUSIONS In the present cranioplasty series using synthetic materials, curvature flattening was a non-invasive and convenient method for skin closure. This method can be beneficial especially in patients requiring a larger craniotomy including convexity regions.
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Affiliation(s)
- Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, Japan.
| | - Hime Suzuki
- Department of Neurosurgery, Sapporo Medical University, Japan
| | - Ryo Ukai
- Department of Neurosurgery, Sapporo Medical University, Japan
| | - Yusuke Kimura
- Department of Neurosurgery, Sapporo Medical University, Japan
| | - Kei Miyata
- Department of Neurosurgery, Sapporo Medical University, Japan
| | | | | | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, Japan
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23
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Sun S, Zhou H, Ding ZZ, Shi H. Risk Factors Associated with the Outcome of Post-Traumatic Hydrocephalus. Scand J Surg 2018; 108:265-270. [PMID: 30428813 DOI: 10.1177/1457496918812210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aim:Post-traumatic hydrocephalus is a common complication that arises after head injury. However, risk factors associated with the outcome of post-traumatic hydrocephalus have seldom been addressed. Therefore, we performed this clinical study to analyze the risk factors affecting the outcome of post-traumatic hydrocephalus in patients with head injuries.Methods:A total of 116 post-traumatic hydrocephalus patients, admitted in our hospital between March 2012 and October 2017 were reviewed. The related factors assessed were age, gender, Glasgow Coma Score on admission, platelet count, plasma fibrinogen levels, D-dimer concentration, subarachnoid hemorrhage, subdural hygroma, cerebral hernia, cisterna ambiens, decompressive craniectomy, cranioplasty, ventriculoperitoneal shunt implantation, intracranial infection, and duration of comatous state. The patient outcomes after 6 months of treatment were evaluated by the Glasgow Outcome Scale. Risk factors for the outcome of post-traumatic hydrocephalus were evaluated by applying logistic regression analysis.Results:Poor outcome was observed in 66.4% of the patients (77/116). Univariate and multivariate analyses revealed that the disappearance of cisterna ambiens, the long duration of comatous state (>2 months), the high levels of plasma fibrinogen, and the ventriculoperitoneal shunt implantation were related to adverse outcomes (p < 0.05).Conclusion:The disappearance of cisterna ambiens, the prolonged duration of comatous state (>2 months), the high plasma fibrinogen levels are the most important factors affecting the outcome of post-traumatic hydrocephalus, and the ventriculoperitoneal shunt implantation is the most critical predictor of the outcome of post-traumatic hydrocephalus.
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Affiliation(s)
- S. Sun
- Department of Neurosurgery, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - H. Zhou
- Department of Neurosurgery, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Z.-Z. Ding
- Department of Neurosurgery, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - H. Shi
- Department of Neurosurgery, The Second Peopleʼs Hospital of Lianyungang, Lianyungang, China
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Abstract
Cranioplasty (CP) is considered a low-risk operation in the field of neurosurgery following decompression craniectomy. Nevertheless, CP is still burdened by surgical complications, among which early or late infections are the most common outcome-threatening ones. Most of infection cases occur within a week after CP. Except that, implant-associated scalp infection is the most common complication, and leads to implant removal in many patients with refractory and recurrent infection. The authors reported a patient presenting with epidural infection about 3 months after titanium implant and cured by anti-infective treatment for 2 weeks.
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Di G, Hu Q, Liu D, Jiang X, Chen J, Liu H. Risk Factors Predicting Posttraumatic Hydrocephalus After Decompressive Craniectomy in Traumatic Brain Injury. World Neurosurg 2018; 116:e406-e413. [DOI: 10.1016/j.wneu.2018.04.216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022]
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Satyarthee GD. Postdecompressive Craniectomy Surgery, Ventriculomegaly, or Hydrocephalus Development: Imaging, Prevention, and Management. J Neurosci Rural Pract 2018; 9:177-179. [PMID: 29725165 PMCID: PMC5912020 DOI: 10.4103/jnrp.jnrp_547_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tandean S, Risfandi M, Japardi I. Pediatric gunshot penetrating head injury: a case report with 2-year follow-up. MEDICAL JOURNAL OF INDONESIA 2018. [DOI: 10.13181/mji.v26i4.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Gunshot is a rare subset of penetrating head injury, and generally the victim dies before arriving at the hospital. This paper reported a case of an intracranial gunshot injury in a 12 year-old boy that was shot by his friend, whose primary intention was to play around, using a revolver. A missile projectile penetrated from mid frontal and came out from right occipital. Vital signs were stable with GCS 8 from physical examination. A rational management strategy should permit a good outcome. The only complications that occured were hydrocephalus, yet it was managed by VP–shunt. Skull defect was closed using titanium mesh. A two-year follow-up showed a good result. The patient was able to do daily activity and back to school again.
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Chen H, Yuan F, Chen SW, Guo Y, Wang G, Deng ZF, Tian HL. Predicting posttraumatic hydrocephalus: derivation and validation of a risk scoring system based on clinical characteristics. Metab Brain Dis 2017; 32:1427-1435. [PMID: 28391551 DOI: 10.1007/s11011-017-0008-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/30/2017] [Indexed: 11/29/2022]
Abstract
Posttraumatic hydrocephalus (PTH) is a disorder of disturbed cerebrospinal fluid (CSF) dynamics after traumatic brain injury (TBI). It can lead to brain metabolic impairment and dysfunction and has a high risk of clinical deterioration and worse outcomes. The incidence and risk factors for the development of PTH after decompressive craniectomy (DC) has been assessed in previous studies, but rare studies identify patients with higher risk for PTH among all TBI patients. This study aimed to develop and validate a risk scoring system to predict PTH after TBI. Demographics, injury severity, duration of coma, radiologic findings, and DC were evaluated to determine the independent predictors of PTH during hospitalization until 6 months following TBI through logistic regression analysis. A risk stratification system was created by assigning a number of points for each predictor and validated in an independent cohort. The model accuracy was assessed by the area under the receiver operating characteristic curve (AUC). Of 526 patients in the derivation cohort, 57 (10.84%) developed PTH during 6 months follow up. Age > 50 yrs (Odd ratio [OR] = 1.91, 95% confidence interval [CI] 1.09-3.75, 4 points), duration of coma ≥1 w (OR = 5.68, 95% CI 2.57-13.47, 9 points), Fisher grade III (OR = 2.19, 95% CI 1.24-4.36, 5 points) or IV (OR = 3.87, 95% CI 1.93-8.43, 7 points), bilateral DC (OR = 6.13, 95% CI 2.82-18.14, 9 points), and extra herniation after DC (OR = 2.36, 95% CI 1.46-4.92, 5 points) were independently associated with PTH. Rates of PTH for the low- (0-12 points), intermediate- (13-22 points) and high-risk (23-34 points) groups were 1.16%, 35.19% and 78.57% (p < 0.0001). The corresponding rates in the validation cohort, where 17/175 (9.71%) developed PTH, were 1.35%, 37.50% and 81.82% (p < 0.0001). The risk score model exhibited good-excellent discrimination in both cohorts, with AUC of 0.839 versus 0.894 (derivation versus validation) and good calibration (Hosmer-Lemshow p = 0.56 versus 0.68). This model will be useful to identify patients at high risk for PTH who may be candidates for preventive interventions, and to improve their outcomes.
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Affiliation(s)
- Hao Chen
- Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Fang Yuan
- Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Shi-Wen Chen
- Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Yan Guo
- Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Gan Wang
- Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Zhi-Feng Deng
- Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Heng-Li Tian
- Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Xuhui District, Shanghai, 200233, China.
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Yang XF, Wang H, Wen L, Huang X, Li G, Gong JB. The safety of simultaneous cranioplasty and shunt implantation. Brain Inj 2017; 31:1651-1655. [PMID: 28898108 DOI: 10.1080/02699052.2017.1332781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND A large cranial defect combined with hydrocephalus is a frequent sequela of decompressive craniectomy (DC) performed to treat malignant intracranial hypertension. Currently, many neurosurgeons perform simultaneous cranioplasty and shunt implantation on such patients, but the safety of this combined procedure remains controversial. METHODS We retrospectively evaluated 58 patients treated via cranioplasty and shunt implantation after DC. Twenty patients underwent simultaneous procedures (simultaneous operation group) and 38 underwent staged procedures (staged operation group). We collected and analysed demographic data, information on disease histories, and clinical findings. RESULTS The overall complication rate was 19%. The two groups did not significantly differ regarding the all-complication (30% vs. 13%), bleeding complication (0% vs. 5%), or treatment failure (15% vs. 3%) rates. However, the rate of surgical site infection/incision healing problems (25% vs. 3%) and the re-operation rate (20% vs. 3%) were significantly higher in the simultaneous operation group. CONCLUSION Patients undergoing simultaneous cranioplasty/shunt implantation may be at a higher risk of infectious complications than those undergoing staged operations.
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Affiliation(s)
- Xiao-Feng Yang
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou City , China
| | - Hao Wang
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou City , China
| | - Liang Wen
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou City , China
| | - Xin Huang
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou City , China
| | - Gu Li
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou City , China
| | - Jiang-Biao Gong
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou City , China
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Sugii N, Matsuda M, Sekine T, Matsumura H, Yamamoto T, Matsumura A. Delayed Brain Edema and Swelling following Craniectomy for Evacuation of an Epidural Abscess that Improved by Cranioplasty: Case Report. J Neurol Surg Rep 2017; 78:e109-e112. [PMID: 28852606 PMCID: PMC5573553 DOI: 10.1055/s-0037-1606315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/05/2017] [Indexed: 11/06/2022] Open
Abstract
We report a unique case of delayed brain swelling following craniectomy that improved rapidly after cranioplasty, and discuss the potential mechanism underlying this delayed and reversible brain swelling. A 22-year-old woman developed surgical site infection after removal of a convexity meningioma. Magnetic resonance imaging revealed an epidural abscess around the surgical site. Subsequently, the abscess was evacuated, and the bone flap was removed. Later, brain edema around the skull defect emerged and progressed gradually, despite resolution of the infection. The edematous brain developed focal swelling outward through the bone defect without ventricle dilatation. Because we suspected that the edema and swelling were caused by the state of the bone defect, we performed a cranioplasty 10 weeks after the bone flap removal, and brain edema improved rapidly. We hypothesized that the brain edema was initially caused by surgical stress and inflammation, followed by compression of cortical veins between the dural edge and brain tissue, leading to disruption of venous return and exacerbation of brain edema. When delayed focal brain edema and external swelling progress gradually after bone flap removal, after excluding other pathological conditions, cranioplasty should be considered to improve cortical venous congestion caused by postsurgical adhesion.
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Affiliation(s)
- Narushi Sugii
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomokazu Sekine
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideaki Matsumura
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Chen Q, Feng Z, Tan Q, Guo J, Tang J, Tan L, Feng H, Chen Z. Post-hemorrhagic hydrocephalus: Recent advances and new therapeutic insights. J Neurol Sci 2017; 375:220-230. [PMID: 28320134 DOI: 10.1016/j.jns.2017.01.072] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
Post-hemorrhagic hydrocephalus (PHH), also referred to as progressive ventricular dilatation, is caused by disturbances in cerebrospinal fluid (CSF) flow or absorption following hemorrhage in the brain. As one of the most serious complications of neonatal/adult intraventricular hemorrhage (IVH), subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI), PHH is associated with increased morbidity and disability of these events. Common sequelae of PHH include neurocognitive impairment, motor dysfunction, and growth impairment. Non-surgical measures to reduce increased intracranial pressure (ICP) in PHH have shown little success and most patients will ultimately require surgical management, such as external ventricular drainage and shunting which mostly by inserting a CSF drainage shunt. Unfortunately, shunt complications are common and the optimum time for intervention is unclear. To date, there remains no comprehensive strategy for PHH management and it becomes imperative that to explore new therapeutic targets and methods for PHH. Over past decades, increasing evidence have indicated that hemorrhage-derived blood and subsequent metabolic products may play a key role in the development of IVH-, SAH- and TBI-associated PHH. Several intervention strategies have recently been evaluated and cross-referenced. In this review, we summarized and discussed the common aspects of hydrocephalus following IVH, SAH and TBI, relevant experimental animal models, clinical translation of in vivo experiments, and potential preventive and therapeutic targets for PHH.
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Affiliation(s)
- Qianwei Chen
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Zhou Feng
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Qiang Tan
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Jing Guo
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China; Department of Neurosurgery, The 211st Hospital of PLA, Harbin 150086, China
| | - Jun Tang
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Liang Tan
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China.
| | - Zhi Chen
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China.
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Adams H, Kolias AG, Hutchinson PJ. The Role of Surgical Intervention in Traumatic Brain Injury. Neurosurg Clin N Am 2016; 27:519-28. [DOI: 10.1016/j.nec.2016.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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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.
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Ramos-Zúñiga R, Mares-Pais R, Gutiérrez-Avila O, Saldaña-Koppel DA. Paradoxical Herniation in the Postcraniectomy Syndrome: Report and Literature Update. J Neurol Surg Rep 2016; 77:e035-8. [PMID: 26929899 PMCID: PMC4726376 DOI: 10.1055/s-0035-1570349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/05/2015] [Indexed: 12/22/2022] Open
Abstract
Introduction The decompressive craniectomy is a surgical strategy widely used with specific criteria to control the refractory intracranial pressure (ICP). However, it is important to warn about the presence of a postcraniectomy syndrome and analyze the risk-benefit on a long term. Case Report A 72-year-old male patient diagnosed with a subarachnoid hemorrhage secondary to the rupture of an anterior circulation aneurysm that develops vasospasm, secondary ischemia, and edema with signs of herniation that required a decompressive craniectomy on a first step. Afterwards, the aneurysm was approached and he consequently developed hydrocephaly. A ventriculoperitoneal shunt is installed, contralateral to the craniectomy, and progressive sinking of the skin flap, there is neurological deterioration and paradoxical herniation. Its association with the clinical deterioration by bronchoaspiration did not allow the cranioplasty to resolve the ICP decompensation. Conclusions The paradoxical herniation as part of the postcraniectomy syndrome is an increasingly common condition identified in adult patients with cortical atrophy, and who have also been treated with ventricular shunt systems. Timely cranioplasty represents the ideal therapeutic plan once the compromise from the mass effect has resolved to avoid complications derived from the decompressive craniectomy per se.
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Affiliation(s)
- Rodrigo Ramos-Zúñiga
- Department of Neurosciences, Universidad de Guadalajara, Translational Neurosciences Institute, Guadalajara, Jalisco, Mexico
| | - Roberto Mares-Pais
- Department of Neurosciences, Universidad de Guadalajara, Translational Neurosciences Institute, Guadalajara, Jalisco, Mexico
| | - Oscar Gutiérrez-Avila
- Department of Neurosciences, Universidad de Guadalajara, Translational Neurosciences Institute, Guadalajara, Jalisco, Mexico
| | - Daniel A Saldaña-Koppel
- Department of Neurosciences, Universidad de Guadalajara, Translational Neurosciences Institute, Guadalajara, Jalisco, Mexico
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Avecillas-Chasin JM. Subdural effusion in decompressive craniectomy. Acta Neurochir (Wien) 2015; 157:2121-3. [PMID: 26264071 DOI: 10.1007/s00701-015-2537-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Josué M Avecillas-Chasin
- Department of Neurosurgery, Institute of Neurosciences, Instituto de Investigación Sanitaria San Calos, Hospital Clínico San Carlos, Prof. Martín Lagos s/n, 28040, Madrid, Spain.
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36
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Renner CIE. Interrelation between Neuroendocrine Disturbances and Medical Complications Encountered during Rehabilitation after TBI. J Clin Med 2015; 4:1815-40. [PMID: 26402710 PMCID: PMC4600161 DOI: 10.3390/jcm4091815] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 08/25/2015] [Accepted: 09/15/2015] [Indexed: 02/05/2023] Open
Abstract
Traumatic brain injury is not a discrete event but an unfolding sequence of damage to the central nervous system. Not only the acute phase but also the subacute and chronic period after injury, i.e., during inpatient rehabilitation, is characterized by multiple neurotransmitter alterations, cellular dysfunction, and medical complications causing additional secondary injury. Neuroendocrine disturbances also influence neurological outcome and are easily overlooked as they often present with diffuse symptoms such as fatigue, depression, poor concentration, or a decline in overall cognitive function; these are also typical sequelae of traumatic brain injury. Furthermore, neurological complications such as hydrocephalus, epilepsy, fatigue, disorders of consciousness, paroxysmal sympathetic hyperactivity, or psychiatric-behavioural symptoms may mask and/or complicate the diagnosis of neuroendocrine disturbances, delay appropriate treatment and impede neurorehabilitation. The present review seeks to examine the interrelation between neuroendocrine disturbances with neurological complications frequently encountered after moderate to severe TBI during rehabilitation. Common neuroendocrine disturbances and medical complications and their clinical implications are discussed.
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Affiliation(s)
- Caroline I E Renner
- Neurological Rehabilitation Centre, University of Leipzig, Muldentalweg 1, D-04828 Bennewitz bei Leipzig, Germany.
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37
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Hatefi M, Azhary S, Naebaghaee H, Mohamadi HR, Jaafarpour M. The Effect of Fenestration of Lamina Terminalis on the Vasospasm and Shunt-Dependent Hydrocephalus in Patients Following Subarachnoid Haemorrhage. J Clin Diagn Res 2015; 9:PC15-8. [PMID: 26393164 DOI: 10.7860/jcdr/2015/13603.6264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS SAH (Sub Arachnoid Haemorrhage) is a life threatening that is associated with complications such as vasospasm and shunt-dependent hydrocephalus. The purpose of this study was to assess the effect of FLT (Fenestration of Lamina Terminalis) on the incidence of vasospasm and shunt-dependent hydrocephalus in ACoA (Anterior Communicating Artery) aneurismal in SAH. MATERIALS AND METHODS The data of 50 ruptured ACoA aneurism patients were selected during the year 2001-2009 admitted to Imam Hussein hospital, Tehran, IR. In a randomized double-blind trial patients assigned in two group {with fenestration (FLT, n=25), without fenestration (No FLT, n=25)}. All patients underwent craniotomy by a single neurosurgeon. Patient's age, sex, Hunt-Hess grade, Fisher grade, vasospasm, presence of hydrocephalus and incidences of shunt-dependent hydrocephalus were compared between groups. RESULTS There were no significant differences among groups in relation to demographic characteristics, neurological scale scores (Hunt-Hess grade) and the severity of the SAH (Fisher grade) (p>0.05). The rate of hydrocephalus on admission, were 24% and 16% in FLT and no FLT group respectively (p>0.05). The shunt placement postoperatively in FLT and no FLT group were 16% and 12% respectively (p>0.05). The clinical vasospasm was 20% and 24% in FLT and no FLT group respectively (p>0.05). CONCLUSION Despite FLT can be a safe method there were not significant differences of FLT on the incidence of vasospasm and shunt-dependent hydrocephalus. A systematic evaluation with multisurgeon, multicentre and with greater sample size to disclose reality is suggested.
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Affiliation(s)
- Masoud Hatefi
- Neurosurgeon, Department of Neurosurgery, Medicine Faculty , Ilam University of Medical Science , Ilam, IR-Iran
| | - Shirzad Azhary
- Neurosurgeon, Department of Neurosurgery, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences , Tehran, IR- Iran
| | - Hussein Naebaghaee
- Neurosurgeon, Department of Neurosurgery, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences , Tehran, IR- Iran
| | - Hasan Reza Mohamadi
- Neurosurgeon, Department of Neurosurgery, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences , Tehran, IR- Iran
| | - Molouk Jaafarpour
- Department of Midwifery, Nursing & amp, Midwifery Faculty, Ilam University of Medical Science , IR-Iran
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