Journal
NEUROLOGY AND THERAPY
Volume 12, Issue 5, Pages 1607-1622Publisher
SPRINGER LONDON LTD
DOI: 10.1007/s40120-023-00511-7
Keywords
Decompressive craniotomy; Traumatic brain injury; External ventricular drain; Post-traumatic hydrocephalus; Glasgow Coma Scale; Glasgow Outcome Scale
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Traumatic brain injury (TBI) is a major cause of mortality and morbidity in adults and children, with post-traumatic hydrocephalus (PTH) being a serious complication associated with neurocognitive impairment and motor dysfunction. The long-term functional outcomes after shunt dependence are uncertain.
IntroductionAs a disorder of the brain in adults and children, traumatic brain injury (TBI) is considered the major cause of mortality and morbidity. As a serious complication of TBI, post-traumatic hydrocephalus (PTH) is commonly identified and significantly associated with neurocognitive impairment, motor dysfunction, and growth impairment. The long-term functional outcomes after shunt dependence are totally not clear.MethodsThis study included 6279 patients between 2012 and 2022. To identify the unfavorable functional outcomes and the PTH-related factors, we carried out univariable logistic regression analyses. To identify the occurrence time of PTH, we conducted the log-rank test and Kaplan-Meier analysis.ResultsMean patient age was 51.03 +/- 22.09 years. Of the 6279 patients with TBI, 327 developed PTH (5.2%). Several PTH development-associated factors, such as intracerebral hematoma, diabetes, longer initial hospital stay, craniotomy, low GCS (Glasgow Coma Scale), EVD (external ventricular drain), and DC (decompressive craniectomy) (p < 0.01), were identified. We also analyzed the factors of unfavorable outcomes after TBI including > 80 years, repeated operations, hypertension, EVD, tracheotomy, and epilepsy (p < 0.01). Ventriculoperitoneal shunt (VPS) itself is not an independent factor of the unfavorable outcome but shunt complication is a strong independent factor of unfavorable outcome (p < 0.05).ConclusionWe should emphasize the practices that can minimize the risks of shunt complications. Additionally, the rigorous radiographic and clinical surveillance will benefit those patients at high risk of developing PTH.
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