Nomogram for predicting post-traumatic hydrocephalus after decompressive craniectomy for traumatic brain injury

SUMMARY OBJECTIVE: This study aimed to develop and validate a practical nomogram to predict the occurrence of post-traumatic hydrocephalus in patients who have undergone decompressive craniectomy for traumatic brain injury. METHODS: A total of 516 cases were enrolled and divided into the training (n=364) and validation (n=152) cohorts. Optimal predictors were selected through least absolute shrinkage and selection operator regression analysis of the training cohort then used to develop a nomogram. Receiver operating characteristic, calibration plot, and decision curve analysis, respectively, were used to evaluate the discrimination, fitting performance, and clinical utility of the resulting nomogram in the validation cohort. RESULTS: Preoperative subarachnoid hemorrhage Fisher grade, type of decompressive craniectomy, transcalvarial herniation volume, subdural hygroma, and functional outcome were all identified as predictors and included in the predicting model. The nomogram exhibited good discrimination in the validation cohort and had an area under the receiver operating characteristic curve of 0.80 (95%CI 0.72-0.88). The calibration plot demonstrated goodness-of-fit between the nomogram's prediction and actual observation in the validation cohort. Finally, decision curve analysis indicated significant clinical adaptability. CONCLUSION: The present study developed and validated a model to predict post-traumatic hydrocephalus. The nomogram that had good discrimination, calibration, and clinical practicality can be useful for screening patients at a high risk of post-traumatic hydrocephalus. The nomogram can also be used in clinical practice to develop better therapeutic strategies.

Lumboperitoneal shunts for the treatment of post-traumatic hydrocephalus

Objective:To assess the effectiveness and safety of lumboperitoneal shunt for treatment of post-traumatic hydrocephalus (PTH).Methods:A retrospective analysis of medical records of patients with lumboperitoneal shunts admitted in Shanghai Tenth People's Hospital from January 2014 to March 2017 was done. Experience with lumboperitoneal shunt placement for PTH was reviewed. The diagnosis of PTH was based on ventricular enlargement with the Evans’ index (EI>0.3) before shunt implantation. Patients were evaluated for improvements in Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), and EI after shunt placement.Results:Totally, the study included 34 PTH patients with the average age of 49.32 years (range: 9-67 years). The average follow-up period was (3.9±3.5) months. Before lumboperitoneal shunt, the GOS score was (4±1), the GCS score was (8.53±3.38), and the EI score was (0.40±0.08). After shunt implantation, the GOS score was (3±1), the GCS score was (10.29±3.15), and the EI score was (0.34±0.13), respectively (P2 and 8 patients GCS improvement=1), 21 (61.76%) patients had EI improvement (18 patients with EI<0.3). There was no complication in this study.Conclusion:Lumboperitoneal shunt placement is safe and effective for PTH, and serious complications are not observed.

Lumboperitoneal shunts for the treatment of post-traumatic hydrocephalus

Objective: To assess the effectiveness and safety of lumboperitoneal shunt for treatment of post-traumatic hydrocephalus (PTH). Methods: A retrospective analysis of medical records of patients with lumboperitoneal shunts admitted in Shanghai Tenth People's Hospital from January 2014 to March 2017 was done. Experience with lumboperitoneal shunt placement for PTH was reviewed. The diagnosis of PTH was based on ventricular enlargement with the Evans' index (EI>0.3) before shunt implantation. Patients were evaluated for improvements in Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), and EI after shunt placement. Results: Totally, the study included 34 PTH patients with the average age of 49.32 years (range: 9-67 years). The average follow-up period was (3.9±3.5) months. Before lumboperitoneal shunt, the GOS score was (4±1), the GCS score was (8.53±3.38), and the EI score was (0.40±0.08). After shunt implantation, the GOS score was (3±1), the GCS score was (10.29±3.15), and the EI score was (0.34±0.13), respectively (P2 and 8 patients GCS improvement=1), 21 (61.76%) patients had EI improvement (18 patients with EI<0.3). There was no complication in this study. Conclusion: Lumboperitoneal shunt placement is safe and effective for PTH, and serious complications are not observed.

Clinical Analysis of Post-traumatic Hydrocephalus

OBJECTIVE: Post-traumatic hydrocephalus is a complication of head injury and can present with several different clinical symptoms. However, the developing factors of post-traumatic hydrocephalus and treatment are still not well known. The authors design the study to focus on incidence, causing diseases and treatment of post-traumatic hydrocephalus. METHODS: The 789patients of traumatic head injury followed by admission treatment over 7days from Jan. 1997 to Dec. 2001, were divided shunt group and shunt free group. We analyzed age, sex, causing diseases, developing time of hydrocephalus and effects of shunt operation in post-traumatic hydrocephalus. RESULTS: The incidence of post-traumatic hydrocephalus for requiring shunt was 9.2% (64cases). Chronic hydrocephalus which developed after 14days of injury was higher incidence (51cases). We found following variables were significiantly related to shunt-dependent hydrocephalus: low GCS score at admission, initial CT finding of traumatic subarachnoid hemorrhage and intracerebral hemorrhage (including intraventricular hemorrhage). The effect of shunt operation was not related with the spinal pressure, but had statistically significant correlation with the response of lumbar drainage. CONCLUSION: We conclude that development of hydrocephalus after head trauma is related to low GCS score, intracerebral hemorrhage (including intraventricular hemorrhage) and subarachnoid hemorrhage. The effect of preoperative lumbar drainage has a significiant role in predicting the result of shunt operation in patient with post-traumatic hydrocephalus.

Pushed-out Scrylic Bone Flap n Post-traumatic Hydrocephalus

We report a case of pushed-out arylic bone flap in a patient with post-traumatic hydrocephalus. He had received a decompressive craniectomy with dura graft due to an epidural hematoma and brain swelling. Later, a cranioplasty had been done. However, the acrylic bone flap was pushed out. In consideration of the pathophysiologic mechanism, cerebrospinal fluid pulse pressure plays an important role. Related literatures are briefly reviewed.