The Treating Effect Of Ventriculo-paritonal Shunt On Patients With Post-traumatic Hydrocephalus

Part1Shunt implantation in a special subgroup of post-traumatic hydrocephalus with normal intracranial pressureBackgroundPost-traumatic hydrocephalus (PTH) is a frequent complication secondary to traumatic brain injury (TBI). Commonly, when intracranial pressure (ICP) is consistently above200mmH2O, shunt implantation should be performed to relieve the hydrocephalus. Additionally, when typical symptoms of normal pressure hydrocephalus (NPH) are present, a shunt is also indicated. However, underlying brain injury from the trauma itself may prevent recovery, and decision-making is difficult when the patient has normal pressure but is too injured to display symptoms of hydrocephalus or has atypical symptoms. This study focused on patients with PTH and normal ICP, analyzed the outcome after shunt implantation, and examined possible prognostic factors. MethodA hospital-based retrospective study was performed in patients who developed normal pressure hydrocephalus after head trauma, from2007to2009. Information regarding patients’demographics, TBI, hydrocephalus, and outcome was collected.ResultA total of76patients were involved in this study. At the12-month follow-up,50patients (66%) showed clear improvement. Before the shunt implantation, the average GOS score was3.2±0.7, and At the12-month follow-up the score was raised to3.4±0.9(paired t-test,p<0.05). The patients were divided to two groups (improved and unimproved) according to whether they were improved after the shunt implantation at follow-up. In this series, the patient’s age and the GOS score before the shunt implantation correlated significantly with an improvement in outcome at the12-month follow-up. However, the patient’s gender, the time from head trauma to the onset of hydrocephalus, and the severity of hydrocephalus did not differ significantly between the groups.ConclusionA retrospective study was performed in a subgroup of patients with PTH who had normal pressure, with a view to analyzing the effects of shunt placement and identifying possible prognostic factors after this procedure. In this series,66%of patients showed clear clinical improvement after shunt implantation with an significant improvement on total GOS score. The patient’s age and the GOS score before the shunt implantation were important predictive parameters for outcome after shunt implantation. Part2Long-term outcomes after shunt implantation in patients with post-traumatic hydrocephalus and severe conscious disturbanceBackgroundPost-traumatic Hydrocephalus (PTH) is a frequent complication secondary to traumatic brain injury (TBI), especially among patients keeping chronic unconscious. PTH is able to prevent unconscious patients to recover after head trauma, and academically a procedure of shunt implantation should be performed to correct PTH for better outcomes. However, actually only a part of patients is able to be benefited from this procedure. The effects of shunt implantation on improving outcomes among these patients are still controversial. This study was aimed to assess the long-term outcomes following shunt implantation among patients who had PTH and kept chronic unconscious.MethodA prospective study was performed to include patients who had PTH and remained in severe conscious disturbance from Mar2010to December2011. All of included patients would have shunt implantation and be closely followed at least for two years to assess final outcomes.ResultThirty-seven patients having PTH were identified. Before shunt implantation, seven patients kept vegetative state (GOS2), and thirty patients kept minimally consciousness with severe disability (GOS3). After shunt implantation, the shunt device was removed because of intracranial infection in two patient, and between them one refused to secondary shunt implantation. Besides, other four patients died because of other complications. Among the remaining thirty three patients, enlarged ventricle shrunk according to CT scan during the first3months following shunt implantation in twenty five patients. Finally fifteen patients had improvement on GOS or MBI score during the two-year follow up. Among them, eleven patients’outcomes improved assessing by GOS or MBI score during the first three months following shunt implantation. During the forth to sixth month following shunt implantation, there were four patients who showed first rise on GOS or MBI score. Beyond six months, no patient showed initial improvement. And among patients who showed improvement, most of them kept improving during a certain time.ConclusionA part of patients who had PTH and remained in severe conscious disturbance would be benefitted from shunt implantation, and the improvement may turn up lately after this procedure. However, it is still difficult to predict the effects of shunt implantation, and the decision whether the shunt implantation should be performed should be cautious.