Role of post-decompressive hydrocephalus in patients with malignant cerebral infarction

Abstract

AIm:The association between post-decompressive hydrocephalus and clinical neurological expression is still unclear. In order to investigate this relationship, the authors analyze series of ventricular morphology and level of consciousness at different clinical stages for patients accepting decompressive craniectomy (DC). results: All 13 patients had ventricular dilatation and two of them had extra-axial CSF collection. Restoration of ventricular dilatation was not observed in all patients after bone flap placement, but extra-axial CSF collection resorbed spontaneously. Four patients accepting permanent CSF diversion had no improvement over neurological expression. Otherwise, two of them complicated with subdural effusion after shunt placement.COnClusIOn: Decompressive craniectomy itself would lead to ventricular dilatation universally. There is no direct association between degree of ventriculomegaly and neurological expression. Permanent CSF diversion surgery as treatment for ventriculomegaly makes no clinical improvement with possible complications of overshunting.

The Conundrum of Ventricular Dilatations Following Decompressive Craniectomy: Is Ventriculoperitoneal Shunt, The Only Panacea?

“…in their study noted ventriculomegaly in all their 13 patients who underwent a DC for malignant middle cerebral artery infarct. [ 20 ] They noted that the neurologic findings were disproportionate to the degree of ventriculomegaly in their patients. However, a mildly bulging brain will hinder the proper placement of bone flap back into the craniotomy defect during cranioplasty.…”

“…[ 17 ] and Lin et al . [ 20 ] reported two out of seven and nine out of thirteen patients who did not require a VPS.…”

“…The incidence of over drainage and subdural collections has been reported to be more in patients undergoing VPS for PDCH. [ 20 ] This happened around 3 months in one patient and in the 5 th month in the second patient. The use of programmable shunts has been very effectively proven for the PDCH in various case series.…”

Simultaneous Cranioplasty and External Ventricular Drain Implantation in Patients with Hydrocephalus: Case Series and Literature Review

“…31 The effectiveness of using the programmable VPS technology in the management of CP after DC is reiterated by other authors, 25,[31][32][33] especially when compared with the permanent VPS, which may even involve excessive drainage and subdural collections. 16,34 However, this is an expensive approach and, therefore, inaccessible to the socioeconomic conditions of most patients. 16 Still, as an alternative for performing simultaneous CP to the management of post-DC HC, a study obtained better results from simultaneous ventriculostomy to CP, followed, in a few days, by the implantation of VPS.…”

Postdecompressive Craniectomy Surgery, Ventriculomegaly, or Hydrocephalus Development: Imaging, Prevention, and Management

“…overdrainage and malfunction. [ 8 ] Hence, stringent patient selection criteria can drastically reduce the need for CSF diversion surgery, and surgery should be offered to selected cases showing significant clinicoradiological concordant and the judicious use of CSF pressure monitoring, if feasible and facility exist for such monitoring values. [ 5 7 ] As it is evident with a study by Rahme et al .…”