J Korean Neurosurg Soc.  2017 Nov;60(6):730-737. 10.3340/jkns.2017.0210.

Factors Associated Postoperative Hydrocephalus in Patients with Traumatic Acute Subdural Hemorrhage

• Kim H
• Lee HS
• Ahn SY
• Park SC
• Huh W

• KMID: 2395794
• DOI: http://doi.org/10.3340/jkns.2017.0210

Abstract

OBJECTIVE
Postoperative hydrocephalus is a common complication following craniectomy in patients with traumatic brain injury, and affects patients' long-term outcomes. This study aimed to verify the risk factors associated with the development of hydrocephalus after craniectomy in patients with acute traumatic subdural hemorrhage (tSDH).
METHODS
Patients with acute traumatic SDH who had received a craniectomy between December 2005 and January 2016 were retrospectively assessed by reviewing the coexistence of other types of hemorrahges, measurable variables on computed tomography (CT) scans, and the development of hydrocephalus during the follow-up period.
RESULTS
Data from a total of 63 patients who underwent unilateral craniectomy were analyzed. Postoperative hydrocephalus was identified in 34 patients (54%) via brain CT scans. Preoperative intraventricular hemorrhage (IVH) was associated with the development of hydrocephalus. Furthermore, the thickness of SDH (p=0.006) and the extent of midline shift before craniectomy (p=0.001) were significantly larger in patients with postoperative hydrocephalus. Indeed, multivariate analyses showed that the thickness of SDH (p=0.019), the extent of midline shift (p<0.001) and the coexistence of IVH (p=0.012) were significant risk factors for the development of postoperative hydrocephalus. However, the distance from the midline to the craniectomy margin was not an associated risk factor for postoperative hydrocephalus.
CONCLUSION
In patients with acute traumatic SDH with coexisting IVH, a large amount of SDH, and a larger midline shift, close follow-up is necessary for the early prediction of postoperative hydrocephalus. Furthermore, craniectomy margin need not be limited in acute traumatic SDH patients for the reason of postoperative hydrocephalus.

Keyword

Brain injuries; Traumatic; Hematoma; Subdural; Craniectomy; Hydrocephalus; Intraventricular hemorrhage

MeSH Terms

Brain
Brain Injuries
Follow-Up Studies
Hematoma
Hematoma, Subdural*
Hemorrhage
Humans
Hydrocephalus*
Multivariate Analysis
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed

Figure

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  Fig. 1 Definition of postoperative hydrocephalus using the modified Frontal Horn Index (a/b) on postoperative follow-up brain computed tomography scans.

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  Fig. 2 Measurement of the maximal thickness of SDH (a) and the extent of the ML shift (b). The extent of the ML shift was determined by measuring the distance from the ML of the cranium to the deviated point of the most posterior part of the third ventricle at the same level. SDH: subdural hemorrhage, ML: midline.

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  Fig. 3 Axial brain CT scan showing brain swelling on postoperative day 7. The rate of brain swelling during first follow-up period is calculated as follows: (R2-R1)/t (time interval between follow CT scans). CT: computed tomography.

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  Fig. 4 Calculation of the area of craniectomy (CE area) using postoperative skull X-ray: CE area=largest transverse diameter (D)×vertical diameter perpendicular to D (d)×π/4.

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  Fig. 5 Receiver operating characteristics curves for prediction of the development of postoperative hydrocephalus using the maximal thickness of SDH (A) and the extent of ML shift (B). SDH: subdural hemorrhage, ML: midline.

Reference

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