Decompressive Craniectomy and Shunt-Amenable Post-Traumatic Hydrocephalus: A Single-Center Experience

Abstract

Background: Prior studies have shown that decompressive craniectomy may be an independent risk factor for the development of post-traumatic hydrocephalus (PTH). It is upon this background that we chose to conduct our single-center retrospective study to establish the possibility of an association between decompressive craniectomy and PTH.

Methods: A retrospective review involving a database of all patients with traumatic brain injury was undertaken. All referrals and admissions with traumatic brain injury, as defined by the Mayo Classification, from January 2012 to May 2022, were included in the subsequent analysis. Statistical analysis was carried out using IBM SPSS version 28.0.1.

Results: The mean age of the cohort was 44.91 ± 19.16 with more males (82.3%) than females (17.7%). Vehicle incident/collision was the most common cause of traumatic brain injury. 84% of the cohort was alive at 30 days, 4% were noted to have an intracranial infection, and 3% underwent shunt insertion procedures, while 14% received decompressive craniotomies as part of their clinical management. There was a statistically significant association between undergoing decompressive craniectomy, and the development of PTH (odds ratio, 4.759 [95% confidence interval, 1.290-17.559]; P = 0.019). The presence of intracranial infection and insertion of an external ventricular drain insertion were also independent predictors of developing PTH.

Conclusions: This study adds to the growing body of work regarding the immediate and long-term effects of the procedure. Although life-saving, PTH, needing shunt insertion, is one of the possible complications that surgeons and patients should be aware of.

Keywords: Brain trauma; CSF, Cerebrospinal fluid; DC, Decompressive craniectomies; DECRA, Decompressive Craniectomy trial; Decompressive craniectomy; EVD, External ventricular drain insertion; GCS, Glasgow coma scale score; GOS, Glasgow outcome scale score; ICU, Intensive care unit; PTH, Post-traumatic hydrocephalus; Post-traumatic hydrocephalus; RESCUEicp trial, Trial of decompressive craniectomy for traumatic intracranial hypertension; Severe traumatic brain injury; TBI, Traumatic brain injury; Trauma; Traumatic brain injury; VPS, Ventriculoperitoneal shunt; Ventriculoperitoneal shunt.