Posttraumatic Hydrocephalus: Risk Factors, Treatment Modalities, and Prognosis
18 July 2017
18 August 2017
13 October 2017 (online)
Background Posttraumatic hydrocephalus (PTH) is a rare clinicopathological entity seen as a sequel of head injury (HI). The described incidence in literature is 7 to 29%.
Aims and Objectives To study the incidence, risk factors, treatment options, and prognosis.
Materials and Methods We retrospectively reviewed our HI database from our institution and identified patients with PTH. The data were obtained from the case files, radiologic records, telephonic interviews, and letters.
Results PTH was diagnosed in 32 patients with mean age being 33.7 ± 16.0 years. Severe HI was present in 22(68.75%) patients, and all of them underwent decompressive craniectomy (DC). Remaining patients had either cranial base repair for cerebrospinal fluid (CSF) leak or conservative management. Average duration for development of PTH after the HI was 11.05 ± 0.58 months in DC group and 17.0 ± 1.25 months in the non-DC group. Patients were treated by CSF diversion (ventriculoperitoneal [VP] or thecoperitoneal shunt) and lumbar subarachnoid drainage in the perioperative period of cranioplasty. Average interval between DC and cranioplasty was 6.21 ± 14.0 months. Mean follow-up was 72.23 ± 0.67 months and observed mortality was 32%. Statistical analysis showed correlation between severity of HI, DC, and development of PTH. DC also had correlation with early development of PTH.
Conclusion The incidence of PTH is low and the etiology is multifactorial. Severe HI, DC, and delayed cranioplasty (>6 months) are associated with higher chances of PTH development. Though VP shunt placement is the established treatment modality, temporary lumbar subarachnoid drain placement in perioperative period of cranioplasty in selected cases is an option.
- 1 Lee SH, Kong DS, Seol HJ, Shin HJ. Endoscopic third ventriculostomy in patients with shunt malfunction. J Korean Neurosurg Soc 2011; 49 (04) 217-221
- 2 Guyot LL, Michael DB. Post-traumatic hydrocephalus. Neurol Res 2000; 22 (01) 25-28
- 3 Licata C, Cristofori L, Gambin R, Vivenza C, Turazzi S. Post-traumatic hydrocephalus. J Neurosurg Sci 2001; 45 (03) 141-149
- 4 Dandy W, Blackman K. Internal hydrocephalus: an experimental, clinical and pathological study. Am J Dis Child 1914; 8: 406-482
- 5 Choi I, Park HK, Chang JC, Cho SJ, Choi SK, Byun BJ. Clinical factors for the development of posttraumatic hydrocephalus after decompressive craniectomy. J Korean Neurosurg Soc 2008; 43 (05) 227-231
- 6 Guyot LL, Michael DB. Post-traumatic hydrocephalus. Neurol Res 2000; 22 (01) 25-28
- 7 Mazzini L, Campini R, Angelino E, Rognone F, Pastore I, Oliveri G. Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome. Arch Phys Med Rehabil 2003; 84 (11) 1637-1641
- 8 Sarkari A, Gupta DK, Sinha S, Kale SS, Mahapatra AK. Post-traumatic hydrocephalus: presentation, management and outcome—an apex trauma centre experience. Indian J Neurotrauma 2010; 7 (02) 135-138
- 9 Kishore PR, Lipper MH, Miller JD, Girevendulis AK, Becker DP, Vines FS. Post-traumatic hydrocephalus in patients with severe head injury. Neuroradiology 1978; 16: 261-265
- 10 Marmarou A, Foda MA, Bandoh K. , et al. Posttraumatic ventriculomegaly: hydrocephalus or atrophy? A new approach for diagnosis using CSF dynamics. J Neurosurg 1996; 85 (06) 1026-1035
- 11 Honeybul S, Ho KM. Incidence and risk factors for post-traumatic hydrocephalus following decompressive craniectomy for intractable intracranial hypertension and evacuation of mass lesions. J Neurotrauma 2012; 29 (10) 1872-1878
- 12 Kawaguchi T, Fujita S, Hosoda K, Shibata Y, Komatsu H, Tamaki N. Treatment of subdural effusion with hydrocephalus after ruptured intracranial aneurysm clipping. Neurosurgery 1998; 43 (05) 1033-1039
- 13 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 (03) 241-246 , discussion 246
- 14 Cardoso ER, Galbraith S. Posttraumatic hydrocephalus—a retrospective review. Surg Neurol 1985; 23 (03) 261-264
- 15 Waziri A, Fusco D, Mayer SA, McKhann II GM, Connolly Jr ES. Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke. Neurosurgery 2007; 61 (03) 489-493 , discussion 493–494
- 16 De Bonis P, Pompucci A, Mangiola A, Rigante L, Anile C. Post-traumatic hydrocephalus after decompressive craniectomy: an underestimated risk factor. J Neurotrauma 2010; 27 (11) 1965-1970
- 17 Beauchamp KM, Kashuk J, Moore EE. , et al. Cranioplasty after postinjury decompressive craniectomy: is timing of the essence?. J Trauma 2010; 69 (02) 270-274
- 18 Chang V, Hartzfeld P, Langlois M, Mahmood A, Seyfried D. Outcomes of cranial repair after craniectomy. J Neurosurg 2010; 112 (05) 1120-1124
- 19 Chun HJ, Yi HJ. Efficacy and safety of early cranioplasty, at least within 1 month. J Craniofac Surg 2011; 22 (01) 203-207
- 20 Schuss P, Vatter H, Marquardt G. , et al. Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J Neurotrauma 2012; 29 (06) 1090-1095
- 21 Rangel-Castilla L, Barber S, Zhang YJ. The role of endoscopic third ventriculostomy in the treatment of communicating hydrocephalus. World Neurosurg 2012; 77 (3-4): 555-560
- 22 Naftel RP, Reed GT, Kulkarni AV, Wellons III JC. Evaluating the Children's Hospital of Alabama endoscopic third ventriculostomy experience using the Endoscopic Third Ventriculostomy Success Score: an external validation study. J Neurosurg Pediatr 2011; 8 (05) 494-501
- 23 De Bonis P, Tamburrini G, Mangiola A. , et al. Post-traumatic hydrocephalus is a contraindication for endoscopic third-ventriculostomy: isn't it?. Clin Neurol Neurosurg 2013; 115 (01) 9-12
- 24 Tribl G, Oder W. Outcome after shunt implantation in severe head injury with post-traumatic hydrocephalus. Brain Inj 2000; 14 (04) 345-354