Deng Hansen, Goldschmidt Ezequiel, Nwachuku Enyinna, Yue John K, Angriman Federico, Wei Zhishuo, Agarwal Nitin, Puccio Ava M, Okonkwo David O
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
Neurol Int. 2021 Oct 19;13(4):527-534. doi: 10.3390/neurolint13040052.
The development of hydrocephalus after severe traumatic brain injury (TBI) is an under-recognized healthcare phenomenon and can increase morbidity. The current study aims to characterize post-traumatic hydrocephalus (PTH) in a large cohort. Patients were prospectively enrolled age 16-80 years old with Glasgow Coma Scale (GCS) score ≤8. Demographics, GCS, Injury Severity Score (ISS), surgery, and cerebrospinal fluid (CSF) were analyzed. Outcomes were shunt failure and Glasgow Outcome Scale (GOS) at 6 and 12-months. Statistical significance was assessed at < 0.05. In 402 patients, mean age was 38.0 ± 16.7 years and 315 (78.4%) were male. Forty (10.0%) patients developed PTH, with predominant injuries being subdural hemorrhage (36.4%) and diffuse axonal injury (36.4%). Decompressive hemicraniectomy (DHC) was associated with hydrocephalus (OR 3.62, 95% CI (1.62-8.07), < 0.01). Eighteen (4.5%) patients had shunt failure and proximal obstruction was most common. Differences in baseline CSF cell count were associated with increased shunt failure. PTH was not associated with worse outcomes at 6 ( = 0.55) or 12 ( = 0.47) months. Hydrocephalus is a frequent sequela in 10.0% of patients, particularly after DHC. Shunt placement and revision procedures are common after severe TBI, within the first 4 months of injury and necessitates early recognition by the clinician.
重度创伤性脑损伤（TBI）后脑积水的发生是一种未得到充分认识的医疗现象，会增加发病率。本研究旨在对一大群患者的创伤后脑积水（PTH）进行特征描述。前瞻性纳入年龄在16 - 80岁、格拉斯哥昏迷量表（GCS）评分≤8分的患者。分析人口统计学资料、GCS评分、损伤严重程度评分（ISS）、手术情况及脑脊液（CSF）。观察指标为分流失败情况以及6个月和12个月时的格拉斯哥预后量表（GOS）评分。以<0.05评估统计学显著性。402例患者中，平均年龄为38.0±16.7岁，男性315例（78.4%）。40例（10.0%）患者发生PTH，主要损伤为硬膜下出血（36.4%）和弥漫性轴索损伤（36.4%）。去骨瓣减压术（DHC）与脑积水相关（比值比3.62，95%可信区间（1.62 - 8.07），<0.01）。18例（4.5%）患者出现分流失败，近端梗阻最为常见。基线脑脊液细胞计数差异与分流失败增加有关。PTH在6个月（P = 0.55）或12个月（P = 0.47）时与较差预后无关。脑积水是10.0%患者常见的后遗症，尤其是在DHC后。在重度TBI后的损伤后前4个月内，分流置管和翻修手术很常见，临床医生需要尽早识别。
