The Risk Factors for Hydrocephalus and Subdural Hygroma after Decompressive Craniectomy in Head Injured Patients

Abstract

ObjectiveThe present study aims to investigate 1) the risk factors for hydrocephalus and subdural hygroma (SDG) occurring after decompressive craniectomy (DC), and 2) the association between the type of SDG and hydrocephalus.MethodsWe retrospectively reviewed the clinical and radiological features of 92 patients who underwent DC procedures after severe head injuries. The risk factors for developing post-traumatic hydrocephalus (PTH) and SDG were analyzed. Types of SDGs were classified according to location and their relationship with hydrocephalus was investigated.ResultsUltimately, 26.09% (24/92) of these patients developed PTH. In the univariate analyses, hydrocephalus was statically associated with large bone flap diameter, large craniectomy area, bilateral craniectomy, intraventricular hemorrhage, contralateral or interhemisheric SDGs, and delayed cranioplasty. However, in the multivariate analysis, only large craniectomy area (adjusted OR=4.66; p=0.0239) and contralateral SDG (adjusted OR=6.62; p=0.0105) were significant independent risk factors for developing hydrocephalus after DC. The incidence of overall SDGs after DC was 55.43% (51/92). Subgroup analysis results were separated by SDG types. Statistically significant associations between hydrocephalus were found in multivariate analysis in the contralateral (adjusted OR=5.58; p=0.0074) and interhemispheric (adjusted OR=17.63; p=0.0113) types.ConclusionFor patients who are subjected to DC following severe head trauma, hydrocephalus is associated with a large craniectomy area and contralateral SDG. For SDGs after DC that occur on the interhemispherical or controlateral side of the craniectomy, careful follow-up monitoring for the potential progression into hydrocephalus is needed.

Postoperative complications influencing the long‐term outcome of head‐injured patients after decompressive craniectomy

“…The occurrence of PTH was found to correlate significantly with unfavorable outcomes, which is consistent with previous studies Honeybul & Ho, 2014). The incidence of PTH is 7.9%-54% in patients with TBI after DC depending on the inclusion criteria and the definitions of hydrocephalus that were used (Fotakopoulos, Tsianaka, Siasios, Vagkopoulos, & Fountas, 2016;Ki et al, 2015;Kim, Lee, Ahn, Park, & Huh, 2017;Su, Lee, Huang, Su, & Chen, 2011). In our study, PTH occurred in 28.93% of the cases.…”

Higroma subdural contralateral tras craniectomía descompresiva

“…La CD consiste en remover una porción del hueso en el lado del hemisferio de cerebro afectado y realizar una apertura de la duramadre para dar más espacio al cerebro edematoso. (6,7) La mayoría de HSD son asintomáticos y cursan con resolución espontánea; sin embargo, pueden presentar síntomas si causan efecto de masa. (4) El HSD con CD es un factor de riesgo para la presencia de hidrocefalia posteriormente; principalmente si el el HSD es contralateral o interhemisférico.…”

“…Jeon et al reportaron que la incidencia de hidrocefalia tras TCE era más frecuente si había presencia de HSD (52.6%), mientras que en el grupo sin HSD era de 10.4%. (1,6,8)…”

“…El segundo mecanismo propuesto es por alteración en la reabsorción del LCR por la aracnoides ya que la CD causa un debilitamiento de la diferencia de PIC pulsátil sistólica-diastólica; que resulta también en acúmulo de LCR. (1,6,9) El tercer mecanismo propuesto, es que al haber ruptura de la aracnoides, hay un decremento de la PIC lo que resulta en drenaje ventricular externo que forma un gradiente de presión que produce un agrandamiento del espacio subdural y acumulación de HSD. El cuarto mecanismo, en el caso de CD, se da por remover una porción de hueso, lo que resulta en formación de un espacio que contiene líquido que se va acumulando.…”

“…El cuarto mecanismo, en el caso de CD, se da por remover una porción de hueso, lo que resulta en formación de un espacio que contiene líquido que se va acumulando. (1,6)…”