ArticleFrontiers in neurology
Clinical manifestations, progression and treatment of post-traumatic hydrocephalus accompanied by contralateral subdural effusion after decompressive craniectomy: a single-center retrospective study.
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Abstract
Background: Post-traumatic hydrocephalus (PTH) and contralateral subdural effusion (cSDE) are common complications after decompressive craniectomy (DC) in severe traumatic brain injury. However, their concurrent occurrence poses diagnostic and therapeutic challenges. This study aims to analyze the clinical features, radiological progression, and treatment outcomes of this condition. Methods: We retrospectively reviewed 436 patients with severe traumatic brain injury who underwent DC at Beijing Tiantan Hospital between September 2018 and January 2026. From this cohort, 21 patients who developed both PTH and cSDE were selected. Their clinical data, radiological features, treatment modalities, and outcomes were analyzed. PTH was defined as Evans' index > 0.3 with clinical symptoms; cSDE was defined as a hypodense crescentic fluid collection over the hemisphere contralateral to the craniectomy site. Results: The overall incidence of concurrent post-traumatic hydrocephalus and contralateral subdural effusion was 4.8% (21/436) among patients who underwent DC, with cSDE occurring at a mean of 15.6 days post-craniectomy. Among the 21 patients, 12 presented with neurological deterioration and underwent burr-hole drainage, and 2 underwent Ommaya reservoir placement due to neurological deterioration. Six patients underwent cranioplasty alone, and 4 patients received cranioplasty combined with ventriculoperitoneal shunt. Seven patients underwent cranioplasty and subsequently received ventriculoperitoneal shunt. Two patients were treated with subdural-peritoneal shunt for refractory subdural effusion, including one patient who, due to the severity of both hydrocephalus and subdural effusion, underwent ventriculoperitoneal shunt and subdural-peritoneal shunt followed by elective cranioplasty. Conclusion: PTH with concomitant cSDE requires individualized, staged management. Cranioplasty may resolve cSDE but often unmasks underlying hydrocephalus, necessitating close postoperative monitoring and timely shunt placement.
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