Phuenpathom N, Ratanalert S, Saeheng S, Sripairojkul B
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
J Med Assoc Thai. 1999 Jan;82(1):46-53.
Ventriculomegaly after head injury is one of controversial debate. Currently there is no definite way to distinguish post-traumatic hydrocephalus (PTH) from cerebral atrophy. The favourable outcome is only from CSF shunting in patients with true post-traumatic hydrocephalus, not hydrocephalus exvacuo.
17 patients with post-traumatic hydrocephalus were retrospectively reviewed from January 1993 to February 1996 to determine risk factors and guidelines for the management of this problem.
These 17 patients represented 1.6 per cent of the 1080 head-injured patients seen at Songklanagarind Hospital during that period. 385 patients were classified as severe head injury in whom 7 were complicated with post-traumatic hydrocephalus. Our study found a high incidence of correlation between PTH and decompressive craniectomy. The late effect of decompressive craniectomy may cause CSF blockage around the convexities and hydrocephalus. The diagnoses were based on clinical manifestations and CT scan appearances. The outcome was related closely to the initial GCS score and the method used for diagnosis.
Post-traumatic hydrocephalus was 1.8 per cent in patients with severe head injury. Late neurological deterioration confirmed by CT scan findings was more useful than CT scan findings alone. CSF shunting was effective in patients with ventriculomegaly who had clinical signs and symptoms of increased intracranial pressure from post-traumatic hydrocephalus.
头部损伤后脑室扩大是一个有争议的话题。目前尚无明确方法区分创伤后脑积水（PTH）和脑萎缩。只有真正的创伤后脑积水患者进行脑脊液分流才会有良好效果，而脑外积水则不然。
回顾性分析1993年1月至1996年2月期间17例创伤后脑积水患者，以确定危险因素及处理该问题的指导原则。
这17例患者占同期宋卡纳加拉医院收治的1080例头部损伤患者的1.6%。385例患者被归类为重度头部损伤，其中7例并发创伤后脑积水。我们的研究发现PTH与去骨瓣减压术之间存在高度相关性。去骨瓣减压术的后期影响可能导致脑凸面周围脑脊液阻塞和脑积水。诊断基于临床表现和CT扫描表现。结果与初始格拉斯哥昏迷评分（GCS）及诊断方法密切相关。
重度头部损伤患者创伤后脑积水发生率为1.8%。经CT扫描结果证实的晚期神经功能恶化比单纯CT扫描结果更有用。对于有创伤后脑积水导致颅内压升高临床体征和症状的脑室扩大患者，脑脊液分流有效。
