Result of Shunt Operation for Post-traumatic Hydrocephalus

Kim, Sei Jung; Lee, Kyeong Seok; Bae, Hack Gun; Yun, Il Gyu; Lee, In Soo

Abstract

We retrospectively reviewed all cases of hydrocephalus shunted in the Soonchunhyang University Hospital within a 5-year period and encountered 12 cases of posttraumatic hydrocephalus. When admitted, seven patients had a Glasgow Coma Scale value of 8 or less and, of the five patients with a Glasgow Coma Scale value above 8, two had an intraventricular hemorrhage, two had a subarachnoid hemorrhage alone. The mean interval from injury to the shunt was 110 days(range from 4 to 311 days). The intracranial pressure was measured by lumbar puncture in eight patients. It was less then 200mmCSF in five patients and above 200mmCSF in three patients. After shunting, six patients(50%) improved markedly and four(33%) slightly. Overall outcome was good recovery in three, moderate disability in three, severe disability in three, vegetative state in two, and death in one patient. Several prognostic factors such as Glasgow Coma Scale value on admission, CT findings, intracranial pressure, interval from injury to the shunt, degree of cortical atrophy, and surgical method are not related to the result of the shunt(p>0.1 by Fisher's test). Since there are no accurate predictors for the result of shunt at present, one can not be sure that the patient with negative prognostic factors will not improve. Shunting rather than simple observation could be a suitable therapeutic trial especially for the bedridden patients.