Clinical analysis of low pressure hydrocephalus after decompressive craniectomy in patients with traumatic brain injury

doi:10.3877/cma.j.issn.2095-123X.2020.02.010

Abstract

Abstract:

Objective

To investigate the pathogenesis, diagnosis and treatment of low pressure hydrocephalus (LPH) after decompressive craniectomy in patients with traumatic brain injury.

Methods

The authors retrospectively analyzed 6 patients who underwent ventriculoperitoneal shunt without anti-siphon device for treatment of LPH after decompressive craniectomy between October 2012 and May 2020 in the neurosurgery department of The First People’s Hospital of Jinzhong. Cranioplasty was undergone in 2 cases with titanium mesh implant in the meantime. To evaluate the effect of surgery, the cognitive function, gait, urine and stool function, and spiral CT imaging of the head were analyzed before operation and 1 week, 1 month and 3 months after operation.

Results

None of the 6 patients had serious complications after surgery. One week to two months after ventriculoperitoneal shunt, the patients’ symptoms improved significantly, and the ventricular system retracted significantly. Ventriculoperitoneal shunt and titanium mesh plasty were performed in stages, and the symptoms and imaging findings of patients improved rapidly after surgery.

Conclusion

Ventriculoperitoneal shunting with adjustable pressure without anti-siphon device were an effective method for LPH after decompressive craniectomy in patients with traumatic brain injury, and the treatment may be more effective to underwent cranioplasty with titanium mesh implant in the next stage.

Key words: Low pressure hydrocephalus, Decompressive craniectomy, Ventriculoperitoneal shunt, Traumatic brain injury, Cranioplasty

Xingqiang Liu, Wenhao Wang, Yinghong Bai, Bin Li, Kai Yang, Zhi Wang, Shutian Wei. Clinical analysis of low pressure hydrocephalus after decompressive craniectomy in patients with traumatic brain injury[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(02): 110-113.

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References 27

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病例	性别	年龄（岁）	临床表现	去骨瓣减压方式	腰穿压力值（mmH₂O）	分流管预设压力档位	二次调整分流管压力档位	颅骨修补
1	男	37	认知力下降，乏力	单侧	75	1.5（70～90 mmH₂O）	1.0（35～55 mmH₂O）	同期
2	女	49	嗜睡，痴呆，小便失禁	单侧	62	1.0（35～55 mmH₂O）	未调整	二期
3	男	52	嗜睡逐渐至浅昏迷，认知力下降，小便失禁	双侧	脑脊液未流出，抽吸后无色清亮脑脊液流出	0.5（15～25 mmH₂O）	间断按压分流泵	二期
4	男	68	认知力下降，自主运动减少	单侧	50	1.0（35～55 mmH₂O）	未调整	二期
5	男	55	浅昏迷，小便失禁	单侧	脑脊液未流出，抽吸后无色清亮脑脊液流出	0.5（15～25 mmH₂O）	未调整	二期
6	男	52	认知力下降	单侧	70	1.0（35～55 mmH₂O）	未调整	同期

病例	性别	年龄（岁）	临床表现	去骨瓣减压方式	腰穿压力值（mmH₂O）	分流管预设压力档位	二次调整分流管压力档位	颅骨修补
1	男	37	认知力下降，乏力	单侧	75	1.5（70～90 mmH₂O）	1.0（35～55 mmH₂O）	同期
2	女	49	嗜睡，痴呆，小便失禁	单侧	62	1.0（35～55 mmH₂O）	未调整	二期
3	男	52	嗜睡逐渐至浅昏迷，认知力下降，小便失禁	双侧	脑脊液未流出，抽吸后无色清亮脑脊液流出	0.5（15～25 mmH₂O）	间断按压分流泵	二期
4	男	68	认知力下降，自主运动减少	单侧	50	1.0（35～55 mmH₂O）	未调整	二期
5	男	55	浅昏迷，小便失禁	单侧	脑脊液未流出，抽吸后无色清亮脑脊液流出	0.5（15～25 mmH₂O）	未调整	二期
6	男	52	认知力下降	单侧	70	1.0（35～55 mmH₂O）	未调整	同期

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