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Risk factors for the development of posttraumatic hydrocephalus after unilateral decompressive craniectomy in patients with traumatic brain injury

  • Tsung-Ming Su
    Affiliations
    Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123 Dapi Road, Niaosong District, Kaohsiung City 83301, Taiwan
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  • Chu-Mei Lan
    Affiliations
    Department of Health Psychology, Chang Jung Christian University, No. 1 Changda Road, Gueiren District, Tainan City 71101, Taiwan
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  • Tsung-Han Lee
    Affiliations
    Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123 Dapi Road, Niaosong District, Kaohsiung City 83301, Taiwan
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  • Shih-Wei Hsu
    Affiliations
    Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123 Dapi Road, Niaosong District, Kaohsiung City 83301, Taiwan
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  • Nai-Wen Tsai
    Affiliations
    Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123 Dapi Road, Niaosong District, Kaohsiung City 83301, Taiwan
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  • Cheng-Hsien Lu
    Correspondence
    Corresponding author at: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung City 833, Taiwan.
    Affiliations
    Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123 Dapi Road, Niaosong District, Kaohsiung City 83301, Taiwan

    Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan

    Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China
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Published:March 01, 2019DOI:https://doi.org/10.1016/j.jocn.2019.02.006

      Highlights

      • Posttraumatic hydrocephalus is a common complication.
      • The outcome in patients with posttraumatic hydrocephalus is worse.
      • Age and contralateral subdural hygroma are risk factors for posttraumatic hydrocephalus.

      Abstract

      Decompressive craniectomy (DC) has been performed increasingly to control medically refractory intracranial hypertension in patients with traumatic brain injury (TBI). Although DC is a potentially life-saving procedure and technically straightforward, it is associated with some significant complications that include subdural hygroma (SDG) and posttraumatic hydrocephalus (PTH). A retrospective analysis of 143 TBI patients who underwent unilateral DC was undertaken to investigate the incidence and risk factors of PTH and investigate the relationship between the types of SDG and PTH. Among these patients, the incidence of PTH was 30.1%. SDG was noted in 25 patients (58.1%) who developed PTH. SDG was noted in 27 patients (27%) without PTH. The patients with PTH had a significantly unfavorable outcome (p < 0.0001). After stepwise logistic regression analyses, only age (p = 0.004, odds ratio [OR] = 1.036, 95% confidence interval [CI] = 1.011–1.061) and contralateral SDG (p < 0.0001, OR = 5.613, 95% CI = 2.232–14.115) remained independently associated with PTH development, and PTH development rate increased by 3.6% with every 1-year increase in age. Close surveillance is indicated in older TBI patients with contralateral SDG after unilateral DC to prompt early detection and timely management of PTH.

      Keywords

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