Hydrocephalus Following Decompressive Craniectomy for Ischemic Stroke

Takeuchi, Satoru; Takasato, Yoshio; Masaoka, Hiroyuki; Hayakawa, Takanori; Yatsushige, Hiroshi; Shigeta, Keigo; Nagatani, Kimihiro; Otani, Naoki; Wada, Koichiro; Nawashiro, Hiroshi; Shima, Katsuji

doi:10.1007/978-3-7091-1434-6_56

Cited by 8 publications

(5 citation statements)

References 23 publications

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“…After DC, the occurrence of ventriculomegaly (VM) or HC is reported with varying incidences (10-45%) mainly due to differences in diagnostic criteria (18)(19)(20)(21). The management of HC in patients in need of cranial reconstruction can be challenging and thus is not precisely defined.…”

Section: Hydrocephalus (Hc)mentioning

confidence: 99%

Cranioplasty Following Decompressive Craniectomy

et al. 2020

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Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic.

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Section: Hydrocephalus (Hc)mentioning

confidence: 99%

Cranioplasty Following Decompressive Craniectomy

et al. 2020

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“…Furthermore, 62% of patients developed an extra-axial fluid collection, even though half of them had no ventricular drainage [86]. Delayed hydrocephalus, however, is a common phenomenon following stroke and has occurred in up to 30 or 47.8% of patients, respectively [87,88]. The presence of pre-, or post-cranioplasty hydrocephalus might have negative effects on the neurological outcome and could be associated with a craniectomy limit <2.5 cm from the midline [89].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review

Zweckberger¹,

Jüettler

Bösel

et al. 2014

Cerebrovasc Dis

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Background: Space-occupying malignant stroke of the middle cerebral artery (MCA) is associated with a high mortality rate of up to 80% under conservative treatment. Although there is convincing evidence that decompression craniectomy can significantly reduce mortality rate and improve neurological outcome in young patients (<60 years), many surgeons are still hesitant to recommend hemicraniectomy for stroke patients. Summary: This review addresses some major issues that appear to be an obstacle to decompression craniectomy, in particular, indicating surgery for patients >60 years or with infarcts of the dominant hemisphere. Furthermore, it emphasizes technical issues such as timing and size of the craniectomy, additional temporal lobectomy, and resection of the temporal muscle, as well as duraplasty and cranioplasty. According to the current literature, decompression craniectomy in older patients can increase survival without most severe disabilities, although, most survivors need assistance in most bodily needs. Involvement of the dominant hemisphere results in aphasia that might partly recover in younger patients, although, considering the neuropsychological deficits caused by infarctions of the nondominant hemisphere, involvement of the dominant hemisphere does not pose as a contraindication for decompression craniectomy. Furthermore, there is convincing evidence that surgery should be performed within 48 h after the onset of symptoms and the size of the craniectomy should be at least 12 cm as a minimum. An additional lobectomy or the resection of the temporal muscle, however, can only be part of individual treatment options. Conceding the weak evidence, it is recommended to close the dura by some form of a duraplasty avoiding cerebrospinal fluid leakages or scarring between the cortex and the scalp leading to injuries during reimplantation of the bone-flap. Complications associated with decompression surgery (hemorrhages, infections, ‘sinking skin-flap syndrome', cerebrospinal fluid leakages, hydrocephalus, seizures), with the infarction itself, or with those that occur during the ICU course (cardiac and pulmonary complications) appear acceptable and are mostly treatable, especially considering the fatal course of conservative treatment. Key Message: This review summarizes the current state of the literature about decompression craniectomy of patients with malignant stroke addressing, in particular, critical surgical issues, and thus, help surgeons to make decisions confidently for/or against performing surgery.

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“…The repair of skull defect in the large area of cerebral infarction may reduce the hydrocephalus, which needs to be further summarized and analyzed. 20 Isolated ventricles are rare. Endoscopic therapy makes it possible not to insert the shunt.…”

Section: Discussionmentioning

confidence: 99%

“…The long-term benefit of hydrocephalus shunt surgery is greater than the short-term effect of the drainage of the lumbar cistern, and the high incidence of complications of the hydrocephalus shunt surgery makes the patients hesitate to choose the operation. The repair of skull defect in the large area of cerebral infarction may reduce the hydrocephalus, which needs to be further summarized and analyzed 20 . Isolated ventricles are rare.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Study on Individualized Surgical Scheme of Hydrocephalus Complicated With Skull Defect

Zhou

Zhang

Gao

et al. 2021

Journal of Craniofacial Surgery

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Objective: This study intends to discuss the individualized selection of surgical scheme of hydrocephalus complicated with skull defect. Methods: A total of 141 patients with hydrocephalus complicated with skull defect in our hospital from January 2012 to December 2018 were the main subjects of this study. Among these 141 patients, 78 patients underwent shunt and skull repair surgery in our hospital. In the present study, according to the classification of bone window tension, and combined with factors that affect the operation, different surgical schemes were selected, namely, repair surgery in the first phase and shunt surgery in the second phase, or simultaneous surgery, or shunt surgery in the first phase and repair surgery in the second phase. Results:The results of the present study show that an individualized surgical scheme can allow for the operation of hydrocephalus complicated with skull defect, without increasing the risk of complications, such as shunt infection, epidural hematoma, etc. Conclusions: The surgical scheme for hydrocephalus complicated with skull defect differs in clinic.

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Hydrocephalus Following Decompressive Craniectomy for Ischemic Stroke

Cited by 8 publications

References 23 publications

Cranioplasty Following Decompressive Craniectomy

Cranioplasty Following Decompressive Craniectomy

Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review

A Clinical Study on Individualized Surgical Scheme of Hydrocephalus Complicated With Skull Defect

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