Show pageBacklinksCite current pageExport to PDFBack to top This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong. ====== Post-traumatic hydrocephalus ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/14S2P3JOHoF7Mo1M-HS3ZBxHNqtGXhp7pdAxHf-yeN4x3AMkBR/?limit=15&utm_campaign=pubmed-2&fc=20240125173302}} ---- ---- Posttraumatic [[hydrocephalus]] (PTH) is a [[complication]] secondary to [[traumatic brain injury]], especially among patients keeping chronic [[unconscious]]. ===== Epidemiology ===== see [[Posttraumatic hydrocephalus epidemiology]]. ===== Etiology ===== see [[Hydrocephalus after traumatic subarachnoid hemorrhage]] see [[Hydrocephalus after decompressive craniectomy]]. ===== Posttraumatic hydrocephalus risk ===== see [[Posttraumatic hydrocephalus risk]]. ===== Treatment ===== The median time of shunting was 80 days (range 20-270 days) after brain trauma ((Denes Z, Barsi P, Szel I, Boros E, Fazekas G. Complication during postacute rehabilitation: patients with posttraumatic hydrocephalus. Int J Rehabil Res.2011 Sep;34(3):222-6. doi: 10.1097/MRR.0b013e328346e87d. PubMed PMID: 21555949.)). ===== Complications===== Postoperative complications were seen in 10 patients (18%): four due to infections and six due to shunt failure. Revision was necessary in all 10 cases. Almost half of the diagnoses of PTH were established in the postacute rehabilitation unit, and all complications after shunt implantation were also recognized there. Precise clinical observation is necessary for diagnosis of PTH. Early diagnosis and treatment are important to prevent secondary complications ((Denes Z, Barsi P, Szel I, Boros E, Fazekas G. Complication during postacute rehabilitation: patients with posttraumatic hydrocephalus. Int J Rehabil Res.2011 Sep;34(3):222-6. doi: 10.1097/MRR.0b013e328346e87d. PubMed PMID: 21555949.)). ===== Outcome ===== It can lead to brain metabolic impairment and dysfunction and has a high risk of clinical deterioration and worse outcomes. On the basis of scores of the functional independence measure, improvement could be observed in 43 cases (78%), the mean score improvement was 40 (2-81) ((Denes Z, Barsi P, Szel I, Boros E, Fazekas G. Complication during postacute rehabilitation: patients with posttraumatic hydrocephalus. Int J Rehabil Res.2011 Sep;34(3):222-6. doi: 10.1097/MRR.0b013e328346e87d. PubMed PMID: 21555949.)). ---- A proportion of patients who had PTH and remained in severe conscious disturbance would benefit from shunt implantation, and the improvement may turn up late after this procedure ((Xin H, Yun S, Jun X, Liang W, Ye-Lin C, Xiao-Feng Y. Long-term outcomes after shunt implantation in patients with posttraumatic hydrocephalus and severe conscious disturbance. J Craniofac Surg. 2014 Jul;25(4):1280-3. doi: 10.1097/SCS.0000000000000583. PubMed PMID: 25006909.)). Several recent studies have indicated that high [[iron]] levels in brain may relate to hydrocephalus development after intracranial hemorrhage. ===== Retrospective observational cohort studies ===== 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 factor]]s 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 ((Romualdo SMF, Juratli TA, Eyüpoglu I, Schackert G, Dengl M, Prem M, Hijazi MM, Sitoci-Ficici KH. [[Post-traumatic hydrocephalus]] after [[decompressive craniectomy]]: a multidimensional analysis of clinical, radiological, and surgical risk factors. Neurosurg Rev. 2025 Jun 21;48(1):523. doi: 10.1007/s10143-025-03673-0. PMID: 40542880.)). ---- 🚨 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. 📉 Retrospective, Predictable, and Predictively Useless While the authors apply multivariate statistics, no predictive model or clinical score is produced. The result? A study that identifies risk factors after the shunt has already been placed — a textbook example of retrospective confirmation bias without translational benefit. 🩺 Surgical Variables: Studied but Ignored The study promises to explore surgical factors, but then dismisses them as statistically insignificant without deeper analysis. Was it the timing? The size of the craniectomy? The bone flap location? None of these variables are interrogated meaningfully. A missed opportunity to challenge surgical dogmas. ⚖️ Outcome Data: Obvious and Overstated Shunted patients had worse outcomes? Of course they did. But without adjusting for injury severity, comorbidities, or ICU complications, the conclusion becomes medically tautological — not enlightening. 🧠 Neurological Subtlety? Nowhere to Be Found No cognitive testing. No neuropsychological follow-up. No differentiation between communicating vs. non-communicating hydrocephalus. The brain is treated like a binary sponge: swollen or drained. 🧪 Innovation Score: 2/10 ✅ Decent sample size ✅ Inclusion of volumetric imaging ❌ No dynamic monitoring ❌ No external validation ❌ No actionable tools for clinicians ❌ No change in practice likely 💬 Final Verdict "A technically competent autopsy of well-known correlations, marketed as innovation. This is not multidimensional analysis — it's [[dimensional padding]]." Unless you're building a PowerPoint on PTH incidence for a basic residency lecture, this paper offers no clinical leverage, no predictive advantage, and no intellectual disruption. Neurosurgeons looking for guidance will leave empty-handed — again. ---- ===== Case reports ===== [[Prolonged Management of Post-Traumatic Hydrocephalus in a Young Adult with Craniectomy Failure and Multimodal Complications A Case Report]] post-traumatic_hydrocephalus.txt Last modified: 2025/06/22 05:08by administrador