J Korean Neurosurg Soc.  2015 Sep;58(3):254-261. 10.3340/jkns.2015.58.3.254.

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

• Ki HJ
• Lee HJ
• Lee HJ
• Yi JS
• Yang JH
• Lee IW

• KMID: 2191378
• DOI: http://doi.org/10.3340/jkns.2015.58.3.254

Abstract

OBJECTIVE
The 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.
METHODS
We 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.
RESULTS
Ultimately, 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.
CONCLUSION
For 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.

Keyword

Decompressive craniectomy; Hydrocephalus; Subdural hygroma

MeSH Terms

Craniocerebral Trauma
Decompressive Craniectomy*
Follow-Up Studies
Head*
Hemorrhage
Humans
Hydrocephalus*
Incidence
Multivariate Analysis
Retrospective Studies
Risk Factors*
Subdural Effusion*

Figure

• 

  Fig. 1 Skull AP (A), lateral (B), and 3D CT reconstruction (C : from above, D : from lateral) with real 3 cm marker after decompressive craniectomy. Distance from midline of skull AP (i) is 123% larger than the true distance on the 3D CT (I), as shown through a compared with a real 3 cm marker (white arrow). Largest AP diameter (D), distance perpendicular to D (d). AP : antero-posterior.

• 

  Fig. 2 Computerized tomography (CT) findings of a patient after decompressive craniectomy. A : CT at 12 days after decompressive craniectomy showing contralateral and ipsilateral subdural hygroma. B : CT at 55 days after decompressive craniectomy showed venetriculomagaly and a ventriculo-peritoneal shunt was placed after. C : CT at 28 days after decompressive craniectomy showing interhemispheric subdural hygroma. D : Patient required a ventriculo-peritoneal shunt due to hydrocephalus.

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