Hydrocephalus after decompressive craniectomy risk factors [Neurosurgery Wiki]

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====== Hydrocephalus after decompressive craniectomy risk factors ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1JEkdnYNUQx3r8vFk7wt7H7Fy3FaIRawFy-kHIqyCZcqXFfwpC/?limit=15&utm_campaign=pubmed-2&fc=20240125172607}}
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Several [[hydrocephalus]] [[predictor]]s were identified; these included distance from the [[midline]], [[hygroma]], [[age]], [[injury severity]], [[subarachnoid]] or [[intraventricular hemorrhage]], delayed time to [[craniotomy]], repeated operation, and [[duraplasty]]. However, results differed among studies. The impact of DC on hydrocephalus remains controversial
((Ding J, Guo Y, Tian H. The influence of decompressive craniectomy on the
development of hydrocephalus: a review. Arq Neuropsiquiatr. 2014
Sep;72(9):715-20. Review. PubMed PMID: 25252237.
)).

It is demonstrated that the occurrence of [[posttraumatic hydrocephalus]] (PTH) is high in patients with large [[decompressive craniectomy]] (DC). 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 defects should be managed deliberately to restore the anatomical and physiological integrity so as to facilitate the neurological resuscitation
((Shi SS, Zhang GL, Zeng T, Lin YF. Posttraumatic hydrocephalus associated with decompressive cranial defect in severe brain-injured patients. Chin J Traumatol. 2011;14(6):343-7. PubMed PMID: 22152137.)).

A study suggests that PTH development is multifactorial and shows that PTH is not that rare. Fotakopoulos et al showed a correlation between craniectomy size and the incidence of PTH
((Fotakopoulos G, Tsianaka E, Siasios G, Vagkopoulos K, Fountas K. Posttraumatic
Hydrocephalus after Decompressive Craniectomy in 126 Patients with Severe
Traumatic Brain Injury. J Neurol Surg A Cent Eur Neurosurg. 2016 Mar;77(2):88-92.
doi: 10.1055/s-0035-1558411. Epub 2015 Sep 9. PubMed PMID: 26351868.
)).



They analyzed the area of craniotomy and the distance of the craniotomy from the midline. Results showed that patients who had undergone craniectomies with a superior limit less than 25 mm from the midline had a markedly increased risk of developing hydrocephalus. They hypothesized, based on the [[Starling resistor]] concept, that during each cardiac cycle in which extracellular fluid is produced during systole and absorbed in diastole, an imbalance between the production and absorption of extracellular fluid in favor of absorption would cause a decrease in brain parenchyma volume and consequently increase the size of the ventricles
((De Bonis P, Pompucci A, Mangiola A, Rigante L, Anile C. Post-traumatic
hydrocephalus after decompressive craniectomy: an underestimated risk factor. J
Neurotrauma. 2010 Nov;27(11):1965-70. doi: 10.1089/neu.2010.1425. PubMed PMID:
20812777.
)).

The presence of interhemispheric hygroma IHHs was a predictive radiological sign of hydrocephalus development within the first 6 months of DC in patients with severe head injury
((Kaen A, Jimenez-Roldan L, Alday R, Gomez PA, Lagares A, Alén JF, Lobato RD.
Interhemispheric hygroma after decompressive craniectomy: does it predict
posttraumatic hydrocephalus? J Neurosurg. 2010 Dec;113(6):1287-93. doi:
10.3171/2010.4.JNS10132. Epub 2010 May 21. PubMed PMID: 20486895.)).