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. 2025 Jun 21;48(1):523.
doi: 10.1007/s10143-025-03673-0.

Post-traumatic hydrocephalus after decompressive craniectomy: a multidimensional analysis of clinical, radiological, and surgical risk factors

Sérgio Miguel Fernandes Romualdo  1 , Tareq Adnan Juratli  2 , Ilker Eyüpoglu  2 , Gabriele Schackert  2 , Markus Dengl  2 , Markus Prem  2 , Mido Max Hijazi  2 , Kerim-Hakan Sitoci-Ficici  2
Affiliations

Post-traumatic hydrocephalus after decompressive craniectomy: a multidimensional analysis of clinical, radiological, and surgical risk factors

Sérgio Miguel Fernandes Romualdo et al. Neurosurg Rev. .

Abstract
in English, French

Decompressive craniectomy is a key treatment for refractory intracranial pressure after severe traumatic brain injury (TBI). Post-traumatic hydrocephalus (PTH) occurs in 7.6-36% of cases, and early diagnosis significantly improves rehabilitation outcomes. This retrospective study analyzed risk factors for shunt-dependent PTH in 126 TBI patients (93 men, 33 women, median age 53 years). Patients were divided into those requiring shunts and those who did not. Clinical and radiological characteristics, including volumetric measurements and surgical techniques, were assessed using SPSS® Statistics 25. The incidence of shunt-dependent PTH was 27%. Multivariate analysis identified significant risk factors: advanced age at craniectomy (p = 0.008; OR 1.048), traumatic subarachnoid hemorrhage in the basal cisterns (p = 0.015; OR 7.545), post-traumatic ischemic infarcts (p = 0.003; OR 5.319), transcalvarial brain herniation (p = 0.012; OR 5.543), subdural hygroma (p = 0.004; OR 8.131), and progression of contusion hemorrhages (p = 0.013; OR 4.386). Operative parameters did not show statistical significance. Neurological outcomes in shunt patients, assessed via the modified Rankin Scale and Extended Glasgow Outcome Scale, were significantly worse than in non-shunt patients (mRS > 3, GOS-E < 5, p = 0.001-0.011). Our findings suggest that subarachnoid hemorrhage in the cisterns, advanced age, hygromas, ischemic infarcts, transcalvarial herniation, and contusion hemorrhage progression are independent risk factors for shunt-dependent PTH. Additionally, shunt placement was linked to poorer neurological outcomes.

Not applicable.

Keywords: Decompressive craniectomy; Hydrocephalus; Post-traumatic hydrocephalus; Traumatic brain injury.

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Conflict of interest statement

Declarations. Ethical approval: This study, approved by the ethics committee of Technische Universität Dresden, was a retrospective observational analysis conducted at the University Hospital Dresden. Consent to participate: Not applicable. This study was a retrospective observational analysis. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of patients´ inclusion/exclusion
Fig. 2
Fig. 2
Shunt-implantation [Study population]
Fig. 3
Fig. 3
Age at the time of DC [no-Shunt vs. Shunt]
Fig. 4
Fig. 4
IVH in the initial cCT [no-Shunt vs. Shunt]
Fig. 5
Fig. 5
tSAH in the basal cisterns [no-Shunt vs. Shunt]
Fig. 6
Fig. 6
Transcalvarial brain herniation in the follow-up cCTs [no-Shunt vs. Shunt]
Fig. 7
Fig. 7
Post-traumatic cerebral infarct in the follow-up cCTs [no-Shunt vs. Shunt]
Fig. 8
Fig. 8
Subdural hygroma in the follow-up cCTs [no-Shunt vs. Shunt]
Fig. 9
Fig. 9
Contusion progression in the follow-up cCTs [no-Shunt vs. Shunt]
Fig. 10
Fig. 10
ROC curve. For the creation of composite curve, each individual variable was given the value of one. For the age parameter (metric), a cut-off value of ≥ 55 years old was used
See this image and copyright information in PMC

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