Abstract
Background: Posttraumatic hydrocephalus (PTH) is a frequent and serious complication that follows a traumatic brain injury (TBI). Its incidence varies greatly from study to study, largely based on different criteria for its diagnosis.
Aims and Objectives: To find out risk factors, treatment modalities and prognosis of cases with Posttraumatic Hydrocephalus.
Material and Methods: This retrospective study was conducted in Department of Neurosurgery at Geetanjali Medical College and Hospital, Udaipur, Rajasthan on the basis of neuro-radiological examination of patients. A total of 500 patients were evaluated for traumatic head Injury in hospital from Jan 2014 – Dec 2017. 40 cases with diagnosis of post traumatic hydrocephalus PTH were identified.
Result: Post traumatic Hydrocephalus (PTH) was observed in 40 patients out of total 500 patients over period of time. Thus, incidence of the PTH was found to be 8.0%. Out of 40 patients, 33 (82.5%) were males and 7 (17.5%) were females. Mean age of PTH patients was 27.96 ± 12. Regarding mode of injury 36 (90.0%) out of 40 injured due to Road Traffic Accidents. Severe HI (GCS ≤ 8) was present in 31 (77.5%) cases. Findings of CT scan showed that majority 29 (72.5%) cases had predominant contusions. 30 (75.0%) cases of HI treated with DI. Out of 30 cases of DC, 23(76.67%) diagnosed with PTH before cranioplasty. Significant correlation was observed between severe HI, DC and time duration between HI and PTH diagnosis. (p = 0.039). Regarding the clinical features at PTH presentation the triad of Memory, Gait and urinary disturbance was observed in 21 (52.5%) cases followed by other features. In majority of cases VP shunt placement was done. Overall mortality was 6 out 0f 31(19.35%) with the outcome measured by GCS. Out of 25 (80.64%) cases who recovered out of 31, 17 (68.0%) had good recovery according to GCS.
Conclusion: PTH could greatly impact morbidity following a severe head injury and could result in increased mortality if it is not recognized and treated.
References
- Choi I, Park HK, Chang JC, Cho SJ, Choi SK, Byun BJ. Clinical factors for the development of posttraumatic hydrocephalus after decompressive craniectomy. J Korean Neurosurgery Soc. 2008;43:227–231.
- Katz RT, Brander V, Sahgal V. Updates on the diagnosis and management of posttraumatic hydrocephalus. Am J Phys Med Rehabil. 1989 Apr. 68(2):91-6.
- Bret P, Hor F, Huppert J, Lapras C, Fischer G. Treatment of cerebrospinal fluid rhinorrhea by percutaneous lumboperitoneal shunting: review of 15 cases. Neurosurgery. 1985;16:44–47.
- Lee SH, Kong DS, Seol HJ, Shin HJ. Endoscopic third ventriculostomy in patients with shunt malfunctions. J Korean Neurosurg Soc 2011; 49(04):217-221.
- Dandy WE, Blackfan KD. Internal hydrocephalus. An experimental, clinical and pathological study. J Neurosurg. 1964; 21:588–635.
- Licata C,Cristofori l, Gambin R, Vivenza C, Turazzi S. Post-Traumatic Hydrocephalus. J Neurosurg Sci 2001; 45(03):141-149.
- Kishor PRS, Lipper MH, Miller JD, Girevendulis AK, Becker DP, Vines FS. Post-traumatic hydrocephalus in patients with severe head injury. Neuroradiology 1978; 16:261-5.
- Tian HL, Xu T, Hu J, Cui YH, Chen H, Zhou LF. Risk factors related to hydrocephalus after traumatic subarachnoid hemorrhage. Surg Neurology2008; 69: 241-246; discussion 246.
- Chuang K, Stroud NL, Zafonte R. Rehabilitation of patients with traumatic brain injury. In: Winn HR, editor. Youmans neurological surgery. Ed 6. Phildelphia, PA: Elsevier Saunders; 2011. pp. 3516–3534. pp. e3511–e3513.
- Jiao QF, Liu Z, Li S, Zhou LX, Li SZ, Tian W, et al. Influencing factors for posttraumatic hydrocephalus in patients suffering from severe traumatic brain injuries. Chin J Traumatol 2007; 10: 159-162.
- De Bonis P, Sturiale CL, Anile C, Gaudino S, Mangiola A, Martucci M, et al. Decompressive craniectomy, interhemis-pheric hygroma and hydrocephalus: a timeline of events? Clinical Neurology Neurosurg 2013; 115: 1308-1312.
- Takeuchi S, Takasato Y, Masaoka H, Hayakawa T, Yatsushige H, Nagatani K, et al. Hydrocephalus after decompressive craniectomy for hemispheric cerebral infarction. J Clin Neuroscience 2013; 20: 377-382.
- Kishore PR, Lipper MH, Miller JD et al. Posttraumatic hydrocephalus in patients with severe Head Injury. Neuroradiology 1978; 16:261-265.
- Marmarou A, Foda MA et al. Posttraumatic ventriculomegaly: Hydrocephalus or Atropy? A new approach for diagnosis using CSF dynamics. J Neurosurg 1996; 85(06):1026-1035.
- Wang LP, Wu CG, Yao J. Risk factors of Posttraumatic Hydrocephalus after Decompressive Craniectomy for patients with craniocerebral trauma. Chin J Trauma. 2014; 30:307–310.
- Chang V, Hartzfeld P, Langlosis M, Mahmood A, Seyfried D. Outcome of cranial repair after craniectomy. J Neurosurg 2010; 112(05):1120-1124.
- Chun HJ, Yi HJ. Efficacy and safety of early cranioplasty, at least within 1 month. J Craniofac surg 2011; 22(01):203-207.
- Schuss P, Vatter H, Marquardt G, et al. Cranioplasty after decompressive craniectomy: the effect of timing of postoperative complications. J Neurotrauma 2012; 29(06):1090-1095.
- De Bonis P, Tamburrini G, Mangiola A, et al. Posttraumatic hydrocephalus is a contraindication for endoscopic third- ventriculostomy: isn’t it? Clin Neurol Neurosurg 2013; 115(01):9-12.
Corresponding Author
Dr Uday Bhaumik
Assistant Professor, Department of Neurosurgery, Geetanjali Medical College and Hospital, Udaipur, India
DOI: https://dx.doi.org/10.18535/jmscr/v6i8.18
