Posttraumatic hydrocephalus associated with decompressive cranial defect in severe brain-injured patients

ObjectiveTo 在经历了 decompressive 部分颅骨切除术(DC ) 并且在这研究被注册讨论受不了在 2004 年 1 月和 2010 年 5 月之间的严格的头损伤的 389 个病人的 management.MethodsA 总数的严格的伤害大脑的病人调查 posttraumatic 脑水肿(PTH ) 的出现。临床的数据回顾地被分析。他们，经历了 DC 的 149 个病人根据 PTH 的存在被划分成二个组：脑水肿组和 nonhydrocephalus 组。在 DC 的包括外科手术前的格拉斯哥昏迷 20 的临床的因素(GCS ) ，双边或单方的解压缩，和 duraplasty 被单个因素分析估计与 PTH.ResultsOf 的出现决定它的关系经历 DC 的 149 个病人，(16.8%) 25 开发了 PTH；当 23 在剩余的之中开发了 PTH (9.6%) 时没有 DC 的 240 个病人。外科手术前的 GCS，双边或单方的解压缩，在 DC 的 duraplasty 显著地与 PTH 的发展被联系。Ventriculoperitoneal 分流在 DC 以后与 PTH 在 25 个病人中的 23 个上被执行。正面的角为导管的放置被比较喜欢。他们中的十六个被操作在之上经由正面的途径并且 7 经由枕骨的途径。在分流外科以后，放射学、临床的改进在 19 个病人被证实。放射学的改进在 2 个病人被发现。一个病人最后死于严重肺病。分流相关的感染发生在 1 个病人，它导致了 catheter.ConclusionsIt 的移动被表明 PTH 的出现在有大 decompressive 的病人高颅骨缺点。有低 GCS 和双边的解压缩的病人趋于在 DC 以后开发 PTH。在 DC 的 Duraplasty 可能便于减少 PTH 的出现。有 PTH 伴随物颅骨缺点的病人应该故意被管理恢复解剖、生理的正直以便便于神经病学的复活。

Objective： To investigate the occurrence of posttraumatic hydrocephalus （PTH） in severe braininjured patients who underwent decompressive craniectomy （DC） and to discuss the management. Methods： A total of 389 patients suffering from severe head trauma between January 2004 and May 2010 were enrolled in this study. Clinical data were analyzed retrospectively. Of them, 149 patients who underwent DC were divided into two groups according to the presence of PTH： hydrocephalus group and nonhydrocephalus group. Clinical factors including preoperative Glasgow Coma Score （GCS）, bilateral or unilateral decompression, and duraplasty in DC were assessed by single factor analysis to determine its relationship with the occurrence of PTH. Results： Of the 149 patients undergoing DC, 25 （16.8%） developed PTH; while 23 developed PTH （9.6%） among the rest 240 patients without DC. Preoperative GCS, bilateral or unilateral decompression, duraplasty in DC were significantly associated with the development of PTH. Ventriculoperitoneal shunt was performed on 23 of 25 patients with PTH after DC. Frontal horn was preferred for the placement of the catheter. Sixteen of them were operated upon via frontal approach and 7 via occipital approach. After shunt surgery, both radiological and clinical improvemerits were confirmed in 19 patients. Radiological improvement was found in 2 patients. One patient died eventually of severe pneumonia. Shunt-related infection occurred in 1 patient, which led to the removal of the catheter. Conclusions： It is demonstrated that the occurrence of PTH is high in patients with large decompressive skull defect. Patients with low GCS and bilateral decompression tend to develop PTH after DC. Duraplasty in DC might facilitate reducing the occurrence of PTH. Patients with PTH concomitant skull defect should be managed deliberately to restore the anatomical and physiological integrity so as to facilitate the neurological resuscitation.