Early cranioplasty associated with a lower rate of post-traumatic hydrocephalus after decompressive craniectomy for traumatic brain injury

Özöner, Barış; Kılıç, Mustafa; Aydin, Levent; Aydın, Seçkin; Arslan, Yusuf; Müslüman, Ahmet Murat; Yılmaz, Adem

doi:10.1007/s00068-020-01409-x

Cited by 15 publications

(15 citation statements)

References 40 publications

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“…Subdural effusion is caused by a hole between the dura mater and the arachnoid wall, and the venous reflux is blocked under high intracranial pressure, resulting in the redistribution of cerebrospinal fluid. As reported in previously published studies, subdural effusion is not only a serious complication affecting the prognosis of patients but also a risk factor for the formation of hydrocephalus (19)(20)(21)(22). These findings support the findings of the present study.…”

Section: Discussionsupporting

confidence: 94%

Risk factors for chronic hydrocephalus in patients with intracerebral hemorrhage complicated by coma after emergency hematoma removal

Haitao¹,

Feng²,

Wang³

2022

Ann Transl Med

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Background: The cerebrospinal fluid circulation of patients with intracerebral hemorrhage (ICH) can be blocked by blood clots, resulting in acute hydrocephalus. However, current research on chronic hydrocephalus (CH) is lacking.Methods: A total of 253 patients with ICH combined with coma treated at The Third People's Hospital of Gansu Province after emergency hematoma removal from January 2018 to January 2020 were included.Patients were divided into the CH group (n=48) and the control group (n=205) depending on whether hydrocephalus occurred or not within 3-12 months after operation. The main clinical characteristics of the two groups were compared, and the risk factors for CH were analyzed. Counting data of the two groups were expressed as "n (%)", and multivariate logistic regression analysis was used to explore the risk factors for CH.Results: Compared with the control group, the proportion of patients with modified Graeb score ≥5 points in the CH group increased significantly (52.08% vs. 21.95%, P=0.000). The proportion of patients with preoperative cerebral hernia increased significantly (37.5% vs. 19.51%, P=0.008). The proportion of patients with preoperative obstructive hydrocephalus increased (43.75% vs. 24.39%, P=0.007). The proportion of patients with postoperative subdural effusion increased (41.67% vs. 13.66%, P=0.000). Multivariate logistic regression analysis showed that a modified Graeb score ≥5 points and postoperative subdural effusion were risk factors for the formation of CH in patients with ICH complicated by coma after emergency hematoma removal (P<0.05). The modified Graeb score has diagnostic value for the formation of CH in patients with ICH combined with coma after emergency hematoma removal, and the area under the curve was 0.653 [P=0.001, 95% confidence interval (CI): 0.561-0.744]. There was no significant difference in preoperative neurological deficit score between the control group and the CH group (19.75±3.03 vs. 19.86±3.01, P=0.113). Compared with the control group, the neurological deficit score at 12 months after operation in the CH group was significantly higher (12.73±2.99 vs. 10.64±2.82, P=0.000). Conclusions: A modified Graeb score >5 points and postoperative subdural effusion are risk factors for the formation of CH in patients with ICH combined with coma after emergency hematoma removal. The formation of CH affects postoperative neurological rehabilitation.

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Section: Discussionsupporting

confidence: 94%

Risk factors for chronic hydrocephalus in patients with intracerebral hemorrhage complicated by coma after emergency hematoma removal

Haitao¹,

Feng²,

Wang³

2022

Ann Transl Med

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“…Otherwise, cranioplasty is performed not only as cosmetic or protective procedure, but also as a therapeutic one. A restoration of cranial vault has a potential to normalize cerebrospinal fl uid circulation and to avoid the need for shunt procedure due to hydrocephalus, factor associated with a worse neurological outcome (13,15,16). Also, it has been described, that in patients after craniectomy, a decreased perfusion and metabo-lism with an associated possible neurological dysfunction occur, often accompanied by "sinking skin fl ap" (7,8,11,12,17).…”

Section: Discussionmentioning

confidence: 99%

“…We have not obtained similar results, most likely due to a limited number of revision-type cranial reconstructions in our cohort. Early cranioplasty is, however, recommended when possible, as it is associated with a better functional outcome (28,30) and possibility of restoring normal cerebrospinal fl uid circulation, thus avoiding the need of shunting (13,15,31). As various authors use different defi nitions of early cranioplasty, a proper determination of ideal timing for cranial reconstruction to achieve the best neurological improvement and to reduce the risk of complications is necessary.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, a shunting procedure after a decompressive craniectomy prior to cranioplasty can provoke sinking skin fl ap syndrome and implantation of programmable valves is therefore recommended (37). In traumatic brain injured patients, cerebrospinal fl uid dynamics might be restored by an early cranioplasty and subsequent shunting is therefore not required (13,15). An adequate treatment of postcraniectomy hydrocephalus remains crucial since it is associated with a worse neurological outcome (13,16) and with an increased risk of bone fl ap resorption after cranioplasty (25).…”

Section: Discussionmentioning

confidence: 99%

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Analysis of clinical efficiency and early postoperative complications after cranioplasty

Hanko¹,

Cmarkova²,

Snopko³

et al. 2021

BLL

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INTRODUCTION: Despite of being considered a routine procedure, cranioplasty is associated with a substantial risk of failure, or postoperative complications. PATIENTS AND METHODS: Postoperative clinical course and rate of complications was assessed in patients undergoing cranioplasty during years 2015-2019 in a retrospective fashion. RESULTS: The most frequent condition requiring cranioplasty was a presence of bone defect after a decompressive craniectomy for traumatic brain injury (45 patients). Revision was needed in 9 cases (12.68 %), removal of the bone fl ap was necessary in 5 patients (7.04 %). The most common complication observed was an unintended intraoperative durotomy, occurring in 9 patients (12.68 %), which was, however, not associated with an increased risk of reoperation. Postoperative improvement of motor functions was observed in 7 patients (9.86 %). Improvement of consciousness occurred in 8 patients (11.27 %). Early cranioplasty was associated with signifi cantly higher odds for surgical revision, patients after previous craniectomy for traumatic brain injury had signifi cantly increased odds for the overall occurrence of complications. CONCLUSIONS: After a cranial reconstruction, complications with a various degree of severity may occur and even the result in need of the implant removal. Postoperative improvement of focal neuro-defi cit is possible as well as improvement on the level of patient's consciousness (Tab. 2, Fig. 2, Ref. 61).

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“…The diagnosis of PTH was done based on a combination of clinical characteristics and positive imaging results. The following characteristics were used: (1) neurological symptoms which included headache and vomiting, nerve deficits, and an altered level of consciousness; (2) the clinical state gradually improved over time but neurological deterioration and disturbance of consciousness worsened again; and (3) the brain CT scan showed progressive ventricular dilation (Evans index >0.3) 5 .…”

Section: Diagnostic Criteria For Post-traumatic Hydrocephalusmentioning

confidence: 99%

Nomogram for predicting post-traumatic hydrocephalus after decompressive craniectomy for traumatic brain injury

Zhuo

Zhang

et al. 2022

Rev. Assoc. Med. Bras.

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OBJECTIVE: This study aimed to develop and validate a practical nomogram to predict the occurrence of post-traumatic hydrocephalus in patients who have undergone decompressive craniectomy for traumatic brain injury. METHODS: A total of 516 cases were enrolled and divided into the training (n=364) and validation (n=152) cohorts. Optimal predictors were selected through least absolute shrinkage and selection operator regression analysis of the training cohort then used to develop a nomogram. Receiver operating characteristic, calibration plot, and decision curve analysis, respectively, were used to evaluate the discrimination, fitting performance, and clinical utility of the resulting nomogram in the validation cohort. RESULTS: Preoperative subarachnoid hemorrhage Fisher grade, type of decompressive craniectomy, transcalvarial herniation volume, subdural hygroma, and functional outcome were all identified as predictors and included in the predicting model. The nomogram exhibited good discrimination in the validation cohort and had an area under the receiver operating characteristic curve of 0.80 (95%CI 0.72-0.88). The calibration plot demonstrated goodness-of-fit between the nomogram's prediction and actual observation in the validation cohort. Finally, decision curve analysis indicated significant clinical adaptability. CONCLUSION: The present study developed and validated a model to predict post-traumatic hydrocephalus. The nomogram that had good discrimination, calibration, and clinical practicality can be useful for screening patients at a high risk of post-traumatic hydrocephalus. The nomogram can also be used in clinical practice to develop better therapeutic strategies.

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Early cranioplasty associated with a lower rate of post-traumatic hydrocephalus after decompressive craniectomy for traumatic brain injury

Cited by 15 publications

References 40 publications

Risk factors for chronic hydrocephalus in patients with intracerebral hemorrhage complicated by coma after emergency hematoma removal

Risk factors for chronic hydrocephalus in patients with intracerebral hemorrhage complicated by coma after emergency hematoma removal

Analysis of clinical efficiency and early postoperative complications after cranioplasty

Nomogram for predicting post-traumatic hydrocephalus after decompressive craniectomy for traumatic brain injury

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