Predictors of Post-operative Hydrocephalus and Subdural hygroma Following Decompressive craniectomy and Its Treatment Modalities. Literature Review and Our Experience

Introduction: To investigate and predict the post-operative hydrocephalus and subdural hygroma collection following decompressive craniectomy and their treatment modalities.

Methods: A retrospective study of emergency operated cases over a 8 year period who were admitted at Golden Hospital Biratnagar between April 2014 and September 2022 was performed. Post-operative hydrocephalus and subdural hygroma and their treatment modalities of 307 patients with traumatic brain injury following trauma who underwent decompressive craniectomy unilateral or bilateral at same period, were reviewed and monitored their clinical outcome. Our study also evaluated the effectiveness of moderately tight bandaging on post-op hydrocephalus and hygroma following DC.

Results: Postoperative hydrocephalus was identified in 82 patients (26.71%). Hydrocephalus was associated with large bone flap diameter, bilateral craniectomy, intraventricular hemorrhage, contralateral or interhemisheric subdural hygroma, and delayed cranioplasty. However, practically large craniectomy area, contralateral subdural hygroma and intraventricular hemorrhage were associated with hydrocephalus that needed further surgical intervention. The other risk factors that we observed were; very early decompressive surgery, distance from the midline to the craniectomy margin, post-operative meningitis etc. Most of the time the clinically significant hydrocephalus needed only temporary CSF diversion by lumbar drainage or external ventricular drainage followed by cranioplasty, however VP shunt was needed in five patients. The incidence of subdural hygroma and hydrocephalus was found lower after we started applying the moderately tight bandage rather than keeping it lax.

Conclusion : Hydrocephalus is a significant morbidity following DC. It is associated with large craniectomy area, contralateral subdural hygroma and intraventricular hemorrhage. VP shunt is required only in those patients who were refractory to temporary CSF diversion methods. Careful monitoring for the potential progression into hydrocephalus is needed clinically. Moderate pressure compression with crepe bandage has good results in reducing the incidence of post-operative hydeocephalus and hygroma. Early cranioplasty reduces the risk of development of hydrocephalus and hygroma.