Posttraumatic Hydrocephalus Following Decompressive Craniectomy in Traumatic Brain Injury: Proportion and Risk Factors

Abstract Background  Posttraumatic hydrocephalus (PTH) is an important cause of morbidity after decompressive craniectomy (DC) following traumatic brain injury (TBI). Early diagnosis and treatment of PTH can prevent further neurological compromise in patients who are recovering from TBI. Objective  The aim of this study was to assess the proportion of patients who develop hydrocephalus after undergoing DC and to identify the factors associated with PTH requiring surgical treatment in patients undergoing DC for TBI. Methods  Data of patients undergoing DC for TBI in the Trauma Neurosurgery Unit, Medical College Hospital, Trivandrum, between June and December 2020 were collected prospectively. Results  A total of 48 patients who underwent DC were studied. Six (12.5%) patients developed PTH. The patients were divided into two groups: PTH (patients who developed hydrocephalus) and non-PTH (patients who did not develop hydrocephalus). Age, sex, mode of injury, severity of injury, and preoperative radiological findings were not associated with the development of PTH. A distance of craniectomy margin from the midline of less than 2.5 cm was found to be statistically significant. No statistical difference was found in the outcome among the PTH and non-PTH groups. Conclusion  Craniectomy with a superior limit too close to the midline can predispose patients undergoing DC to the development of hydrocephalus. We therefore suggest performing wide DCs with the superior limit greater than 25 mm from the midline.