Risk factors for post-traumatic hydrocephalus following decompressive craniectomy

Nasi, Davide; Gladi, Maurizio; Rienzo, Alessandro Dı; Somma, Lucia di; Moriconi, Elisa; Iacoangeli, Maurizio; Dobran, Mauro

doi:10.1007/s00701-018-3639-0

Cited by 44 publications

(43 citation statements)

References 19 publications

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“…In 11 studies (comparative case control or cohort), we asked whether early CP (i.e., CP ≤3 months) versus later CP differently impacted the rate of hydrocephalus following DC [ Table 1]. [1][2][3][4][5]7,9,[10][11][12]14] Statistical method for meta-analysis e meta-analysis was performed using STATA/IC 13.1 statistical package (StataCorp LP, College Station, TX, USA). e log odds ratios (LORs) and 95% confidence intervals for each outcome were then reckoned as by "early" and "late" time points.…”

Section: Study Selection and Outcomementioning

confidence: 99%

“…Ten studies were retrospective, and one study involved a prospective cohort. [1][2][3][4][5]7,9,[10][11][12]14] All papers were classified as level of evidence "IIIB. "…”

Section: Inclusion Of Eleven Studiesmentioning

confidence: 99%

“…Indications for initial DC included; arteriovenous malformations, ischemic or hemorrhagic stroke, infection, ruptured aneurysm, trauma (i.e., traumatic brain injury [TBI] alone -3 studies), [3,8,11] or tumors. Nine of 11 studies defined early CP as CP as those performed within equal to/ or <3 postoperative months versus late CP, occurring after 3 postoperative months.…”

Section: Indications For DCmentioning

confidence: 99%

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Can early cranioplasty reduce the incidence of hydrocephalus after decompressive craniectomy? A meta-analysis

Nasi¹,

Dobran²

2020

Surgical Neurology International

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Background: Do alterations of cerebrospinal fluid dynamics secondary to decompressive craniectomy (DC) lead to hydrocephalus, and can this effect be mitigated by early cranioplasty (CP)? In this meta-analysis, we evaluated whether the timing of CP decreased the incidence of postoperative hydrocephalus. Methods: We performed a systematic search of PubMed/MEDLINE, Scopus, and the Cochrane databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for English language articles (1990–2020). We included case series, case–control, and cohort studies, and clinical trials assessing the incidence of hydrocephalus in adult patients undergoing early CP (within 3 months) versus late CP (after 3 months) after DC. Results: Eleven studies matched the inclusion criteria. The rate of postoperative hydrocephalus was not significantly different between the early (=96/1063; 9.03%) and late CP (=65/966; 6.72%) group (P = 0.09). Only in the three studies specifically reporting on the rate of hydrocephalus after DC performed to address traumatic brain injury (TBI) alone was there a significantly lower incidence of hydrocephalus with early CP (P = 0.01). Conclusion: Early CP (within 90 days) after DC performed in TBI patients alone was associated with a lower incidence of hydrocephalus. However, this finding was not corroborated in the remaining eight studies involving CP for pathology exclusive of TBI.

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Section: Study Selection and Outcomementioning

confidence: 99%

“…Ten studies were retrospective, and one study involved a prospective cohort. [1][2][3][4][5]7,9,[10][11][12]14] All papers were classified as level of evidence "IIIB. "…”

Section: Inclusion Of Eleven Studiesmentioning

confidence: 99%

Section: Indications For DCmentioning

confidence: 99%

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Can early cranioplasty reduce the incidence of hydrocephalus after decompressive craniectomy? A meta-analysis

Nasi¹,

Dobran²

2020

Surgical Neurology International

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“…We studied with keen interest the article by Nasi et al regarding the risk factors for post-traumatic hydrocephalus (PTH) after decompressive craniectomy in traumatic brain injury patients and their 6-month clinical outcomes [2].…”

Section: Dear Editormentioning

confidence: 99%

“…

Dear Editor,We studied with keen interest the article by Nasi et al regarding the risk factors for post-traumatic hydrocephalus (PTH) after decompressive craniectomy in traumatic brain injury patients and their 6-month clinical outcomes [2].We commend the authors on undertaking an evaluation of these risk factors as early prediction of hydrocephalus may facilitate early anticipatory management and result in a better long-term outcome vis-à-vis a late responsive intervention. In this study, the authors have found radiological finding of interhemispheric hygroma and delayed cranioplasty to be significantly associated with development of post-traumatic hydrocephalus.The predictive potential of interhemispheric hygroma has been reported by other authors as well.

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mentioning

confidence: 99%

Post-traumatic hydrocephalus following decompressive craniectomy: how well can it be predicted?

et al. 2018

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Dear Editor,We studied with keen interest the article by Nasi et al. regarding the risk factors for post-traumatic hydrocephalus (PTH) after decompressive craniectomy in traumatic brain injury patients and their 6-month clinical outcomes [2].We commend the authors on undertaking an evaluation of these risk factors as early prediction of hydrocephalus may facilitate early anticipatory management and result in a better long-term outcome vis-à-vis a late responsive intervention. In this study, the authors have found radiological finding of interhemispheric hygroma and delayed cranioplasty to be significantly associated with development of post-traumatic hydrocephalus.The predictive potential of interhemispheric hygroma has been reported by other authors as well. According to these findings, subdural hygroma preceded the development of PTH and can be a good predictor for the same. One of the studies by Kaen et al.[1] reported a sensitivity of 94% and specificity of 96%. However, Kaen et al. [1] also observed the appearance of PTH after the resolution of subdural hygroma. The authors failed to acknowledge this interesting finding and have not commented on the status of subdural hygroma in their surgical series at the time of development of PTH.There have been several studies evaluating different aspects of debate between early and late cranioplasty. It is traditionally classified at an arbitrary cutoff of 3 months. The authors have used this cutoff of 3 months only which seems to be counterintuitive for the purpose of this study because the as-sessment of post-traumatic hydrocephalus was done at 1 month after decompressive craniectomy in this study. Thus, it must have been classified at 1 month to understand the impact cranioplasty has on the development of PTH. An early cranioplasty done between 1 and 3 months after decompressive craniectomy is not expected to benefit a patient in terms of development of PTH at 1 month vis-à-vis delayed cranioplasty.In this study, there were 37 patients who developed PTH out of whom 3 underwent early cranioplasty. The authors have described 3 patients who developed PTH and were managed by cranioplasty and lumbar drain insertion. It must have been made clear that these 3 patients are the same or not. If they are, then cranioplasty is more of a therapeutic intervention done for PTH rather than a risk factor for the same. It does not preclude the predictive potential of early cranioplasty but to assess that either the association must be evaluated with PTH at >3 months or the cutoff time for cranioplasty must be reduced accordingly. The choice between ventriculoperitoneal shunt and urgent cranioplasty and lumbar drain insertion as the therapeutic modality should also have been explained. Compliance with ethical standardsConflict of interest The authors declare that they have no conflict of interest. References 1. Kaen A, Jimenez-Roldan L, Alday R, Gomez PA, Lagares A, Alén JF, Lobato RD (2010) Interhemispheric hygroma after decompressive craniectomy: does it predict posttraumatic hydroc...

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Establishment of a model to predict mortality after decompression craniotomy for traumatic brain injury

Wu,

Zhang,

Chen

et al. 2024

Brain and Behavior

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BackgroundThe mortality rate of patients with traumatic brain injury (TBI) is still high even while undergoing decompressive craniectomy (DC), and the expensive treatment costs bring huge economic burden to the families of patients.ObjectiveThe aim of this study was to identify preoperative indicators that influence patient outcomes and to develop a risk model for predicting patient mortality by a retrospective analysis of TBI patients undergoing DC.MethodsA total of 288 TBI patients treated with DC, admitted to the First Affiliated Hospital of Shantou University Medical School from August 2015 to April 2021, were used for univariate and multivariate logistic regression analysis to determine the risk factors for death after DC in TBI patients. We also built a risk model for the identified risk factors and conducted internal verification and model evaluation.ResultsUnivariate and multivariate logistic regression analysis identified four risk factors: Glasgow Coma Scale, age, activated partial thrombin time, and mean CT value of the superior sagittal sinus. These risk factors can be obtained before DC. In addition, we also developed a 3‐month mortality risk model and conducted a bootstrap 1000 resampling internal validation, with C‐indices of 0.852 and 0.845, respectively.ConclusionsWe developed a risk model that has clinical significance for the early identification of patients who will still die after DC. Interestingly, we also identified a new early risk factor for TBI patients after DC, that is, preoperative mean CT value of the superior sagittal sinus (p < .05).

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Risk factors for post-traumatic hydrocephalus following decompressive craniectomy

Abstract: Our results showed that delayed cranial reconstruction was associated with an increasing rate of PTH after DC. The presence of an interhemispheric hygroma was an independent predictive radiological sign of PTH in decompressed patients for severe TBI.

Cited by 44 publications

References 19 publications

Can early cranioplasty reduce the incidence of hydrocephalus after decompressive craniectomy? A meta-analysis

Can early cranioplasty reduce the incidence of hydrocephalus after decompressive craniectomy? A meta-analysis

Post-traumatic hydrocephalus following decompressive craniectomy: how well can it be predicted?

Establishment of a model to predict mortality after decompression craniotomy for traumatic brain injury

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