Clinical Study of Cranioplasty Combined With Ipsilateral Ventriculoperitoneal Shunt in the Treatment of Skull Defects With Hydrocephalus

Abstract

Objective: To explore the clinical effect and safety of cranioplasty combined with ipsilateral ventriculoperitoneal shunts in the treatment of skull defects with hydrocephalus. Methods: The clinical data of 78 patients with skull defects with hydrocephalus were analyzed retrospectively. All patients were treated with cranioplasty and ventriculoperitoneal shunts in 1 stage, including 35 cases of cranioplasty combined with ipsilateral ventriculoperitoneal shunts (ipsilateral operation group) and 43 cases of contralateral operations (contralateral operation group). Results: The incision length (28.97 AE 4.55 cm), operation time (139.00 AE 42.27 minutes), and intraoperative hemorrhage (174.57 AE 79.35 mL) in the ipsilateral operation group were significantly better than those in the contralateral operation group (respectively they were 37.15 AE 5.83 cm, 214.07 AE 34.35 minutes, and 257.21 AE 72.02 mL), and the difference was statistically significant (t ¼ 6.786, 8.656, and 4.815, all P < 0.05).The degree of postoperative hydrocephalus was significantly improved in both groups, but there was no statistically significant difference in the degree of hydrocephalus between the 2 groups (P > 0.05). Among the postoperative complications, there was no statistically significant difference in infection, epilepsy, subdural effusion, titanium plate effusion, or excessive cerebrospinal fluid drainage between the 2 groups (P > 0.05), but the incidence of intracranial hemorrhage in the ipsilateral operation group (2.86%) was significantly lower than that in the contralateral operation group (20.93%, x 2 ¼ 4.138, P ¼ 0.042). The postoperative Glasgow Coma Scale scores of the 2 groups were improved compared with those before the operation (P < 0.05), and there was no statistically significant difference in the postoperative Glasgow Coma Scale scores (P > 0.05). At 6 months after surgery, there was no statistically significant difference in Glasgow Outcome Scale effectiveness between the 2 groups (x 2 ¼ 0.005, P ¼ 0.944). Conclusions:Cranioplasty combined with ipsilateral ventriculoperitoneal shunt has the same therapeutic effect as a contralateral operation, but it has the advantage of a short operation time, less intraoperative trauma, less bleeding, and less risk of intracranial hemorrhage, which is suitable for clinical applications.

Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel

“…Nevertheless, no relevant consideration has been reported about diagnostic proof of ongoing PTH ( Table 2 ). Yan et al (2022) reported the ventricular/biparietal (V/Bp) ratio >0.26 as an assessment of the degree of hydrocephalus and to drive surgery. The authors reported the one-staged operation conducive to early recovery, especially with ipsilateral VPS ( Table 2 ) ( Yan et al, 2022 ).…”