Bagherzadeh Sadegh, Bahari Leila, Roohollahi Faramarz
Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Neurosurg Rev. 2025 Jan 22;48(1):72. doi: 10.1007/s10143-025-03232-7.
Traumatic Brain Injury (TBI) is a major cause of death, disability, and healthcare expenses worldwide. Decompressive craniectomy (DC) is a critical surgery used when there is uncontrollable swelling in the brain following a TBI. Research has shown that 27.4% of patients who underwent DC for severe TBI developed hydrocephalus, leading to a significant impact on their quality of life and long-term outlook. We conducted a review of hydrocephalus risk factors in adult TBI patients who underwent DC to better understand the factors contributing to this condition. The comprehensive search strategy covered PubMed, Scopus, Embase, and Web of Science databases from inception to June 2024. The search terms "Craniectomy AND Hydrocephalus AND Trauma* and Decompress*" were applied to titles, abstracts, and keywords. Out of 887 publications found, 591 remained after removing duplicates. After reviewing titles and abstracts, 480 articles were excluded. Of the remaining 111 articles, 87 were excluded for various reasons, leaving 22 for the meta-analysis. The cumulative sample size was 2888, and the incidence of hydrocephalus was 20.5%. We analyzed 28 variables and of them, 13 were associated with hydrocephalus, Subrachnoid hemorrhage (OR:1.75), Intraventricular hemorrhage (OR: 2.49), At least one pupil dilation (OR: 2.01), Preoperative GCS < 6, Craniectomy Margin Distance from Midlineless than 21 mm, size of craniectomy greater than 106.75 cm2, TCHBV greater than 69, bilateral craniectomy (OR: 3.75), Postoperative intracranial infection (OR: 2.7), Postoperative Cerebral infarction (OR: 2.74), interhemispheric Hygroma (OR: 5.53), contralateral Hygroma (OR: 4.18), and bilateral Hygroma (OR: 2.55). Hydrocephalus following DC is notably linked to an adverse outcome (Glasgow Outcome Scale 1, 2, 3 OR: 4.06). After decompressive craniectomy, hydrocephalus significantly affects traumatic brain injury recovery. Our analysis found that the craniectomy margin distance from the midline less than 21 mm is a modifiable risk factor for hydrocephalus development. Other significant risk factors will help diagnose at-risk patients, address hydrocephalus promptly, and ultimately improve patient outcomes.
创伤性脑损伤（TBI）是全球范围内死亡、残疾和医疗费用的主要原因。去骨瓣减压术（DC）是在TBI后脑肿胀无法控制时使用的一种关键手术。研究表明，因重度TBI接受DC手术的患者中有27.4%发生了脑积水，这对他们的生活质量和长期预后产生了重大影响。我们对接受DC手术的成年TBI患者的脑积水危险因素进行了综述，以更好地了解导致这种情况的因素。全面的检索策略涵盖了从创刊到2024年6月的PubMed、Scopus、Embase和Web of Science数据库。检索词“颅骨切除术 AND 脑积水 AND 创伤* AND 减压*”应用于标题、摘要和关键词。在找到的887篇出版物中，去除重复项后还剩591篇。在审阅标题和摘要后，排除了480篇文章。在其余的111篇文章中，由于各种原因又排除了87篇，剩下22篇进行荟萃分析。累积样本量为2888，脑积水的发生率为20.5%。我们分析了28个变量，其中13个与脑积水相关，蛛网膜下腔出血（OR：1.75）、脑室内出血（OR：2.49）、至少一侧瞳孔散大（OR：2.01）、术前格拉斯哥昏迷量表（GCS）<6、颅骨切除术边缘距中线距离小于21mm、颅骨切除面积大于106.75cm²、创伤性脑损伤后大脑静脉高压（TCHBV）大于69、双侧颅骨切除术（OR：3.75）、术后颅内感染（OR：2.7）、术后脑梗死（OR：2.74）、半球间脑积液（OR：5.53）、对侧脑积液（OR：4.18）和双侧脑积液（OR：2.55）。DC术后的脑积水与不良预后（格拉斯哥预后量表1、2、3级，OR：4.06）显著相关。去骨瓣减压术后，脑积水显著影响创伤性脑损伤的恢复。我们的分析发现，颅骨切除术边缘距中线距离小于21mm是脑积水发生的一个可改变的危险因素。其他重要的危险因素将有助于诊断高危患者，及时处理脑积水，并最终改善患者的预后。
