Post-traumatic hydrocephalus : Presentation, management and outcome — An apex trauma centre experience

Abstract

The reported incidence of post-traumatic hydrocephalus (PTH) in literature varies from 0.7–29%. It is a treatable complication of head injury and presents with different clinical syndromes. We manage 38 cases of post-traumatic hydrocephalus in our hospital between January 2009 and April 2010. Clinicoradiology was studied at initial trauma, and at presentation with symptoms suggestive of increased ICP. Post ventriculo-peritoneal shunt outcome was analyzed. Sixty-eight percent cases were of severe head injury. Contusions (73.6%) and SAH (50%) were the most common CT findings. Sixty-five percent cases had been managed by decompressive craniectomy at the time of initial injury. Deterioration in consciousness (57.8%) and hemiparesis (26.3%) were most common presenting features of PTH, usually after 65±38 days (mean±SD) of initial injury. Patients were managed by antibiotic impregnated ventriculo-peritoneal shunt. Shunt revision and infection rates were 18.4% and 12.8% respectively. Thirty cases (78.9%) improved, 2 (5.2%) showed no improvement and 6 (15.7%) died. PTH is a treatable complication of head injury with a favorable outcome and therefore should be aggressively managed by CSF shunting.

Keywords

head injury - hydrocephalus - ventriculo-peritoneal shunting

^* Submitted for Best paper award during 19^th Neurotrauma Conference held at Chennai, 20-22 Aug 2010.

• References

• 1 Dandy W, Blackfan KD. Internal hydrocephalus. An experimental, clinical and pathological study. Am J Dis Child 1914; 08: 406-482
• 2 Cardoso ER, Galbraith S. Posttraumatic hydrocephalus — A retrospective review. Surg Neurol 1985; 23: 261-264
• 3 Hawkins TD, Lloyd AD, Fletcher GI, Hanka R. Ventricular size following head injury: A clinico-radiological study. Clin Radiol 1976; 27: 279-289
• 4 Loshakov VA, Iusef ES, Likhterman LB, Kravchuk AD, Shcherbakova E, Tissen TP. et al The diagnosis and surgical treatment of posttraumatic hydrocephalus. Zh Vopr Neirokhir Im N N Burdenko 1993; 18-22
• 5 Groswasser Z, Cohen M, Reider-Groswasser I, Stern MJ. Incidence, CT findings and rehabilitation outcome of patient with communicative hydrocephalus following severe head injury. Brain Injury 1988; 02: 267-272
• 6 Guyot LL, Micheal DD. Post traumatic hydrocephalus. Neurol Res 2000; 22: 25-28
• 7 Kishore PR, Lipper MH, Miller JD, Giravendulis AK, Becker DP, Vines FS. Post traumatic hydrocephalus in patients with severe head injury. Neuro Radiol 1978; 16: 261-265
• 8 Gudeman SK, Kishore PR, Becker DP. et al Computed tomography in the evaluation of incidence and significance of post-traumatic hydrocephalus. Radiology 1981; 141: 397-402
• 9 Philippon J, George B, Visot A, Cophignon J. Post-operative hydrocephalus. Neurochirurgie 1976; 22: 111-117
• 10 Beyerl B, Black PM. Post traumatic hydrocephalus. Neurosurgery 1984; 15: 257-261
• 11 Takagi H, Tamaki Y, Morii S, Ohwada T. Rapid enlargement of ventricles within seven hours after head injury. Surg Neurol 1981; 16: 103-105
• 12 Licata C, Cristofori L, Gambin R, Vivenza C, Turazzi S. Post-traumatic hydrocephalus. J Neurosurg Sci 2001; 45: 141-149
• 13 Rodrigues D, Sharma RR, Sousa J, Pawar SJ, Mahapatra AK, Lad SD. Post-traumatic hydrocephalus in severe head injury-series of 22 cases. Pan Arab J Neurosurg 2000; 04: 63-67
• 14 Bhatoe HS, Batish VK. Post head injury hydrocephalus. Ind J Neurotrauma 2005; 02: 131-133
• 15 Jiao QF, Liu Z, Li S, Zhou LX, Li SZ, Tian W, You C. Influencing factors for post-traumatic hydrocephalus in patients suffering from severe traumatic brain injuries. Chinese J Traumatology 2007; 10: 159-162
• 16 Tian HL, Xu T, Hu J, Cui YH, Chen H, Zhou LF. Risk factors related to hydrocephalus after traumatic subarachnoid hemorrhage. Surg Neurol 2008; 69: 241-246
• 17 Choi I, Park H, Chang J, Cho S, Choi S, Byun B. Clinical factors for the development of posttraumatic hydrocephalus after decompressive craniectomy. J Korean Neurosurg Soc 2008; 43: 227-231
• 18 Butler AB, Maffeo CJ, Johnson RN, Bass NH. Alteration of CSF outflow in acute subarachnoid hemorrhage; effect of blood components on outflow resistance and vascular transport of CSF in arachnoid villus endothelium. In: Cervos-Navarro J, Fritschka E. (eds) Cerebral Microcirculation and Metabolism. Raven Press; New York: 1981: 409-414
• 19 Foroglou G, Zander E. Post-traumatic hydrocephalus and measurement of cerebrospinal fluid pressure. Acta Radiol Diagn (Stockh) 1972; 13: 524-530
• 20 Phuenpathom N, Ratanalert S, Saeheng S, Sripairojkul B. Posttraumatic hydrocephalus: experience in 17 consecutive cases. J Med Assoc Thai 1999; 82: 46-53
• 21 Waziri A, Fusco D, Mayer SA, McKhann 2nd GM, Connolly Jr ES. Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke. Neurosurgery 2007; 61: 489-493