Post-traumatic hydrocephalus – incidence, risk factors, treatment, and clinical outcome

Abstract

Objectives

Post-traumatic hydrocephalus (PTH) is well-known after traumatic brain injury (TBI), but there is limited evidence regarding patient selection for ventriculo-peritoneal (VP)-shunt treatment. In this study, we investigated the incidence and risk factors for PTH and the indication for and outcome after shunt treatment.

Materials and methods

In this retrospective study, 836 TBI patients, treated at our neurointensive care (NIC) unit at Uppsala university hospital, Sweden, between 2008 and 2018, were included. Demography, admission status, radiology, treatments, and outcome variables were evaluated.

Results

Post-traumatic ventriculomegaly occurred in 46% of all patients at NIC discharge. Twenty-nine (3.5%) patients received a VP-shunt. Lower GCS M at admission, greater amount of subarachnoid hemorrhage, meningitis, decompressive craniectomy (DC), and ventriculomegaly at NIC discharge were risk factors for receiving a VP-shunt. Fourteen of the PTH patients showed impeded recovery or low-pressure hydrocephalus symptoms, of whom 13 experienced subjective clinical improvement after shunt treatment. Five PTH patients showed deterioration in consciousness, of whom four improved following shunt treatment. Five DC patients received a shunt due to subdural hygromas (n =2) or external brain herniation (n = 3), of whom two patients improved following treatment. Five patients were vegetative with concurrent ventriculomegaly and these patients did not have any positive shunt response. Altogether, 19 (66%) PTH patients improved after shunt surgery.

Conclusion

Post-traumatic ventriculomegaly was common, but few developed symptomatic PTH and received a VP-shunt. Patients with low-pressure hydrocephalus symptoms had the best shunt response, whereas patients with suspected vegetative state exhibited a minimal shunt response.

Keywords:

• Neurointensive care
• post-traumatic hydrocephalus
• traumatic brain injury
• ventriculo-peritoneal shunt

Acknowledgement

The authors express our gratitude to the NIC staff for attentive patient care. The study was funded by the Department of Neuroscience, Uppsala University.

Ethical approval

All procedures performed in the studies involving humans were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments. The study was approved by Uppsala University Regional Ethical Board. Informed consent was obtained by the next of kin.

This work was conducted at the Uppsala University Hospital, Department of Neurosurgery.

Disclosure statement

The authors declare no conflict of interest.

Additional information

Funding

The study was funded by the Department of Neuroscience, Uppsala University.