ABSTRACT
Objective To compare the effect and complications of lumboperitoneal shunt (LP) and ventriculoperitoneal shunt (VP) in treatment of posttraumatic hydrocephalus (PTH).Methods A retrospective study was made on 150 cases of posttraumatic communicating hydrocephalus managed with LP or VP from June 2013 to June 2015.There were 65 cases [36 males, 29 females;(47.2 ±8.2) years of age] in LP group and 85 cases [53 males, 32 females;(44.6 ± 7.3) years of age] in VP group.Therapeutic effect and complications were analyzed postoperatively.Results Period of follow-up was 3-27 months, which shoued Total effective rate of 97％ in LP group and 94％ in VP group (P ＞0.05).Postoperative complications were mainly hematoma, infection, shunt obstruction, shunt exposure, excessive shunt and inadequate shunt.At the follow-up, there were 3 subdural hematoma, 4 intracranial infection, 2 shunt obstruction, 3 excessive shunt and 1 inadequate shunt in VP group, but 1 subdural hematoma, 1 intracranial infection, 1 shunt exposure and l excessive shunt in LP group.Good results were achieved in the two groups after regulation of the shunt pressure or reoperation.In comparison, incidence of complications was 6％ in LP group versus 15％ in VP group (P ＜ 0.05).Rate of shunt removal and reoperation in LP group were both 2％, but were 7％ and 8％ respectively in VP group (P ＜ 0.01).Conclusions Both shunt procedures are effective for posttraumatic hydrocephalus, while LP is a better choice in clinical application for the lower complication incidence, shunt removal rate and reoperation rate.
ABSTRACT
Objective To investigate the effect of ventricle-peritoneal (V-P) shunt in treatment of patients who developed post-traumatic hydrocephalus (PTH) with no symptoms or with atypical symptoms due to an excessively severe traumatic brain injury (TBI).Methods A retrospective study was performed in patients who developed PTH with atypical symptoms undergone V-P shunt from January 2004 to June 2007.Patients' general information,TBI data,PTH severity and postoperative follow-up data were collected and applied to assay the improvement rate in prognosis and its associated factors.Results Thirty-one patients were involved in this study.After 12 months of follow-up,20 (65％) patients revealed significant improvements in clinical symptoms.Among 10 patients who developed PTH after decompressive craniectomy,cranioplasty was performed following V-P shunt and significant improvements were observed in nine patients.Patients' age and severity of PTH based on CT evaluation before shunt placement were strongly correlated with the surgical outcome.Conclusions Most PTH patients with atypical symptoms can benefit from V-P shunt.Additionally,younger patients and those with less severe PTH before V-P shunt are expected a better outcome.
ABSTRACT
Objective To analyze the occurrence of traumatic carotid cavemons fistula (TCCF) resulted from the fracture of basilaris cranii, in order to find out the related factors to outcomes and to discuss the approaches to improving prognosis.Method Data of 312 patients with the fracture of skull base complicatcd with TCCF con-firmed angiography from 1999 to 2005 were analyzed. These patients were classified into patients with disable and patients without disabed. The factors potentially impacting on outcomes were analyzed. Results The overall inci-dence of TCCF in 312 patients with fracture of basilaris cranii was 3.8% .The incideucs of TCCF occurred in pa-tients with the fracture of anterior fossa, middle fossa and posterior fossa accounted for 2.4%, 8.3 % and 1.7 %, respectively. Between two cohorts of patients, there were no difference in age, gender, number of embelization proce-dares performed and the time from injury to appearence of the first symptom except the differencc in time from ap-pearence of the first symptom to the intravascular embohzation performed (P>0.05). Conclusions A relatively high incidence of TCCF occurs in patients with middle fossa fractures, especially those with transverse or oblique fractures. Prompt diagnosis and intervention can not be emphasized in case of patients with TCCF, and non inva-sive techniques for the early detection of TCCF under certain circumstance after brain or facial trauma should be considered so as to avoid a miss in the early diagnosis of middle fossa fracture to ensure favourable outcomes.