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A Reappraisal of the Necessity of a Ventriculoperitoneal Shunt After Decompressive Craniectomy in Traumatic Brain Injury

  • Yu, Seunghan (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Choi, Hyuk Jin (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Lee, Jung Hwan (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Ha, Mahnjeong (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Kim, Byung Chul (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital)
  • Received : 2020.11.03
  • Accepted : 2020.12.04
  • Published : 2020.12.30

Abstract

The goal of this study was to evaluate the hypothesis that not every patient with hydrocephalus after decompressive craniectomy needs cerebrospinal fluid diversion, and that cranioplasty should be performed before considering cerebrospinal fluid diversion. Methods: Data were collected from 67 individual traumatic brain injury patients who underwent cranioplasty between January 1, 2019 and December 31, 2019. Patients' clinical and radiographic progression was reviewed retrospectively based on their medical records. Results: Twenty-two of the 67 patients (32.8%) had ventriculomegaly on computed tomography scans before cranioplasty. Furthermore, 38 patients showed progressive ventriculomegaly after cranioplasty. Of these 38 patients, only six (15.7%) showed worsening neurologic symptoms, which were improved by the tap test; these patients eventually underwent ventriculoperitoneal shunt placement. Conclusions: Cerebrospinal fluid diversion is not always required for radiologically diagnosed ventriculomegaly in traumatic brain injury patients after decompressive craniectomy. A careful clinical and neurologic evaluation should be conducted before placing a shunt.

Keywords

References

  1. Jeong TS, Kim WK, Jang MJ. Cranioplasty results after the use of a polyester urethane dural substitute (Neuro-Patch®) as an adhesion prevention material in traumatic decompressive craniectomy. J Trauma Inj 2019;32:195-201. https://doi.org/10.20408/jti.2019.030
  2. Kim J, Kim JH, Kim JH, Kwon TH, Roh H. Outcomes of cranioplasty using autologous bone or 3D-customized titanium mesh following decompressive craniectomy for traumatic brain injury: differences in complications. J Trauma Inj 2019;32:202-9. https://doi.org/10.20408/jti.2019.033
  3. Kim JH, Kim JH, Kwon TH, Chong K, Hwang SY, Yoon WK. Aseptic bone flap resorption after cranioplasty with autologous bone: incidence, risk factors, and clinical implications. World Neurosurg 2018;115:e111-8. https://doi.org/10.1016/j.wneu.2018.03.197
  4. Schuss P, Vatter H, Oszvald A, Marquardt G, Imohl L, Seifert V, et al. Bone flap resorption: risk factors for the development of a long-term complication following cranioplasty after decompressive craniectomy. J Neurotrauma 2013;30:91-5. https://doi.org/10.1089/neu.2012.2542
  5. Alvis-Miranda H, Castellar-Leones SM, Moscote-Salazar LR. Decompressive craniectomy and traumatic brain injury: a review. Bull Emerg Trauma 2013;1:60-8.
  6. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011;364:1493-502. https://doi.org/10.1056/NEJMoa1102077
  7. Annan M, De Toffol B, Hommet C, Mondon K. Sinking skin flap syndrome (or Syndrome of the trephined): a review. Br J Neurosurg 2015;29:314-8. https://doi.org/10.3109/02688697.2015.1012047
  8. Yang XF, Wang H, Wen L, Huang X, Li G, Gong JB. The safety of simultaneous cranioplasty and shunt implantation. Brain Inj 2017;31:1651-5. https://doi.org/10.1080/02699052.2017.1332781
  9. Pachatouridis D, Alexiou GA, Michos E, Voulgaris S. Timing of cranioplasty and shunt placement. Brain Inj 2018;32:529. https://doi.org/10.1080/02699052.2018.1429663
  10. Pachatouridis D, Alexiou GA, Zigouris A, Michos E, Drosos D, Fotakopoulos G, et al. Management of hydrocephalus after decompressive craniectomy. Turk Neurosurg 2014;24:855-8.
  11. Heo J, Park SQ, Cho SJ, Chang JC, Park HK. Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures. J Neurosurg 2014;121:313-8. https://doi.org/10.3171/2014.2.JNS131480
  12. Dujovny M, Fernandez P, Alperin N, Betz W, Misra M, Mafee M. Post-cranioplasty cerebrospinal fluid hydrodynamic changes: magnetic resonance imaging quantitative analysis. Neurol Res 1997;19:311-6. https://doi.org/10.1080/01616412.1997.11740818
  13. Fodstad H, Love JA, Ekstedt J, Friden H, Liliequist B. Effect of cranioplasty on cerebrospinal fluid hydrodynamics in patients with the syndrome of the trephined. Acta Neurochir (Wien) 1984;70:21-30. https://doi.org/10.1007/BF01406039
  14. Fodstad H, Ekstedt J, Friden H. CSF hydrodynamic studies before and after cranioplasty. Acta Neurochir Suppl (Wien) 1979;28:514-8.
  15. Gooch MR, Gin GE, Kenning TJ, German JW. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 2009;26:E9.
  16. Schuss P, Borger V, Guresir Á, Vatter H, Guresir E. Cranioplasty and ventriculoperitoneal shunt placement after decompressive craniectomy: staged surgery is associated with fewer postoperative complications. World Neurosurg 2015;84:1051-4. https://doi.org/10.1016/j.wneu.2015.05.066
  17. Pollack IF, Albright AL, Adelson PD. A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Hakim-Medos Investigator Group. Neurosurgery 1999;45:1399-408; discussion 1408-11. https://doi.org/10.1097/00006123-199912000-00026
  18. Portnoy HD, Chopp M, Branch C, Shannon MB. Cerebrospinal fluid pulse waveform as an indicator of cerebral autoregulation. J Neurosurg 1982;56:666-78. https://doi.org/10.3171/jns.1982.56.5.0666
  19. Winkler PA, Stummer W, Linke R, Krishnan KG, Tatsch K. Influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism. J Neurosurg 2000;93:53-61. https://doi.org/10.3171/jns.2000.93.1.0053
  20. Haan J, Thomeer RT. Predictive value of temporary external lumbar drainage in normal pressure hydrocephalus. Neurosurgery 1988;22:388-91. https://doi.org/10.1227/00006123-198802000-00020
  21. Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J. The predictive value of cerebrospinal fluid dynamic tests in patients with th idiopathic adult hydrocephalus syndrome. Arch Neurol 1995;52:783-9. https://doi.org/10.1001/archneur.1995.00540320059013
  22. Walchenbach R, Geiger E, Thomeer RT, Vanneste JA. The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2002;72:503-6.
  23. Fernández-Mendez R, Richards HK, Seeley HM, Pickard JD, Joannides AJ; UKSR collaborators. Current epidemiology of cerebrospinal fluid shunt surgery in the UK and Ireland (2004-2013). J Neurol Neurosurg Psychiatry 2019;90:747-54. https://doi.org/10.1136/jnnp-2018-319927
  24. Stein SC, Guo W. Have we made progress in preventing shunt failure? A critical analysis. J Neurosurg Pediatr 2008;1:40-7. https://doi.org/10.3171/PED-08/01/040
  25. Schuss P, Vatter H, Marquardt G, Imohl L, Ulrich CT, Seifert V, et al. Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J Neurotrauma 2012;29:1090-5. https://doi.org/10.1089/neu.2011.2176