Neurotraumatology

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

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In a retrospective observational cohort study Romualdo et al. from the Department of Neurosurgery Faculty of Medicine, Technische Universität Dresden University Hospital Carl Gustav Carus published in the Neurosurgical Review to identify clinical, radiological, and surgical risk factors associated with the development of shunt-dependent posttraumatic hydrocephalus (PTH) in patients who underwent decompressive craniectomy following severe traumatic brain injury (TBI). Shunt-dependent post-traumatic hydrocephalus (PTH) occurred in 27% of patients after decompressive craniectomy for severe TBI. Independent risk factors included older age, basal cistern subarachnoid hemorrhage, post-traumatic ischemic infarcts, transcalvarial herniation, subdural hygroma, and progressive contusion hemorrhages. Surgical parameters were not predictive. Patients requiring shunt placement had significantly worse neurological outcomes 5).

🚨 The Illusion of Multidimensionality Despite claiming a “multidimensional” analysis, the study delivers a monotonous list of obvious associations—many of which have been reported in the literature for over a decade. Subarachnoid hemorrhage, infarction, hygroma, contusion progression… yes, thank you, we knew that. What’s new? Almost nothing.

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Long-Term Mortality of Patients With Head Injuries—A 10-Year Follow-up Study With Population Controls

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In a retrospective, population-based cohort study with matched controls and longitudinal follow-up, Heinonen et al. from Tampere University Hospital, Helsinki University Hospital, and Harvard Medical School in the Neurosurgery Journal compared 10-year survival rates and causes of death between patients with traumatic head injuries treated at a university hospital and matched population controls. They aimed to identify factors associated with long-term mortality after TBI.

Patients with head injuries exhibited significantly reduced long-term survival compared to matched controls, even after excluding early mortality. However, patient-related characteristics (e.g., comorbidities, lifestyle factors) — more than injury severity itself — appeared to drive this increased mortality risk.

Notably, even patients without documented TBI (likely mild or undiagnosed) showed decreased survival, suggesting an under-recognized long-term impact of head injury across all severity levels 2).

In this population-based cohort study, the authors track 10-year mortality in over 1,900 patients with head injuries versus 9,600 matched controls. Unsurprisingly, trauma patients die more — especially from alcohol, accidents, and “patient characteristics.” The conclusion? It’s not the injury; it’s the person. This study doesn’t just underdeliver — it underthinks.

🧠 1. Conceptual Cowardice: “Patient Characteristics” as a Black Box

The study’s main conclusion — that patient-related factors, not injury severity, explain increased mortality — is not only reductive but evasive. The term “patient characteristics” serves as a statistical landfill for all the unmeasured, uncontrolled, and misunderstood variables: mental health, addiction, social deprivation, neurobehavioral sequelae… all dumped under one lazy label.

Rather than confront the neuropsychiatric aftermath of head trauma, the authors retreat behind correlational shields.

❝They died because of who they were, not what happened to them.❞ — That’s not science. That’s resignation.

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Effectiveness of subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas – a multicenter experience

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In a retrospective multicenter cohort study Lim et al. from the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Departments of Neurosurgery, Radiology, Bioinformatics, and Canon Stroke and Vascular Research Center, Gates Vascular Institute, Albany Medical Center, Icahn School of Medicine at Mount Sinai, New York, University of South Florida Morsani College of Medicine, Tampa, Florida, USA – Department of Neurosurgery and Brain Repair Yale University, New Haven, Connecticut, USA – Department of Molecular Biophysics and Biochemistry published in the Journal of NeuroInterventional Surgery to o evaluate the combined effectiveness of the Subdural Evacuating Port System (SEPS) and Middle Meningeal Artery Embolization (MMAE) in chronic subdural hematoma treatment (cSDH). Specifically, the authors aimed to assess: How well the combination of SEPS + MMAE reduces hematoma volume, The safety profile of this combined approach, Predictive factors influencing drainage success and recurrence rates, and concluded that the combined use of SEPS and MMAE is a safe and effective treatment option for patients with chronic subdural hematomas (cSDH). It resulted in significant hematoma volume reduction and a relatively low recurrence rate. Several clinical and radiographic factors were identified as predictors of treatment success

📉 1. The Myth of Innovation-by-Combination

Pairing two well-known procedures—SEPS and MMAE—does not inherently create innovation. Yet, the authors present this as a groundbreaking paradigm, despite:

  • No control group (e.g., SEPS alone, MMAE alone),
  • No randomization,
  • No comparative outcome measures beyond radiographic volume.

It’s procedural layering disguised as progress.

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Fluids, Electrolytes, and Nutrition in the Critically Ill Patient with Neurotrauma

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* Type of Study: Narrative Review * Authors: Thomas et al. * Institution and City: University of Pennsylvania, Philadelphia, PA, USA * Journal: Neurosurgical Clinics of North America*, July 2025 * Purpose: To synthesize current clinical practices and considerations for fluid, electrolyte, and Nutritional Management in Critically Ill Neurotrauma Patients. * Conclusions: Isotonic saline remains the fluid of choice for resuscitation in TBI. Hypertonic saline is increasingly favored over mannitol for hyperosmolar therapy. Electrolyte imbalances are prevalent and necessitate close management. Nutritional optimization requires multidisciplinary coordination due to the elevated metabolic demands in TBI 1).

Critical Peer Review

1. Scientific Rigor & Methodology:

This narrative review lacks systematic methodology, which limits reproducibility and objectivity. There is no explicit discussion of inclusion/exclusion criteria for literature cited, nor a transparency framework for evaluating evidence quality. Future iterations would benefit from at least a semi-structured approach or alignment with PRISMA-ScR guidelines for scoping reviews.

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Factors affecting outcomes following burr hole drainage of chronic subdural hematoma: a single-center retrospective study

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In a retrospective single-center cohort study, Zolnourian et al., from the University Hospital Southampton and Queen’s Hospital, Barking, Havering, & Redbridge University Hospitals NHS Trust, London, United Kingdom, published in the Journal of Neurosurgery, aimed to identify preoperative and perioperative factors that influence clinical outcomes, complications, and hospital length of stay in adult patients undergoing burr hole drainage for chronic subdural hematoma (CSDH), in order to improve patient selection and surgical decision-making.

They concluded that favorable short-term outcomes were primarily associated with nonmodifiable preoperative factors such as age under 80, preadmission independence, higher Glasgow Coma Scale motor score, lower ASA grade, and fewer regular medications. Surgical variables like laterality or the number of burr holes did not significantly impact outcomes. The use of subdural drains was linked to better discharge outcomes but not to recurrence or complications. These findings provide evidence-based criteria to guide surgical decision-making and patient counseling.

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📉 1. Redundancy Rebranded as Discovery

The headline findings — that younger, fitter patients with fewer medications and lower ASA scores fare better — are hardly groundbreaking. These are well-known prognostic factors repeated in countless prior studies. Yet the authors present them as if freshly uncovered, bypassing the fact that any intern with access to the NICE guidelines could have written this paper in a call room.

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