Hydrocephalus and Cerebrospinal Fluid Analysis Following Severe Traumatic Brain Injury: Evaluation of a Prospective Cohort

A team of UPMC researchers including Hansen Deng, MD; Enyinna Nwachuku, MD; Zhishuo Wei; Nitin Agarwal, MD; Ava M. Puccio, RN, PhD; and David O. Okonkwo, MD, PhD, along with colleagues from other institutions, recently published research on the development of post-traumatic hydrocephalus (PTH) following severe traumatic brain injury (TBI).

PTH occurs when there is a buildup of excess cerebrospinal fluid in the brain that fails to drain properly. 

While PTH is often seen in severe TBI patients who underwent a decompressive hemicraniectomy (DHC) to relieve pressure in the brain, it is also seen in severe TBI patients who did not undergo DHC. 

There is little existing research on the impact of intracranial pressure, cerebral perfusion pressure, and brain tissue oxygenation (PbtO2) on the development of PTH.

Therefore, the purpose of this study was to identify the rate of occurrence of PTH in severe TBI patients both with and without DHC, determine predictors of hydrocephalus, and evaluate the outcomes of patients who experienced shunt malfunction to improve the clinical management of this condition.

Data was collected from 402 patients with severe TBI who were enrolled in the Brain Trauma Research Center database from May 2000 to July 2014. The patients enrolled in this study received treatment at UPMC and ranged in age from 16 to 80 years old. The study consisted of two cohorts that categorized patients based on whether they underwent DHC. 

A variety of potential risk factors including patient demographics, Glasgow Coma Scale score, Injury Severity Score (ISS), surgical history, and cerebrospinal fluid were analyzed to better understand the occurrence of PHT following TBI. 

Study results showed that 40 of the 402 (10.0%) patients with severe TBI developed PTH. 18 of the 402 (4.5%) patients experienced shunt failure and it was found that the differences in cerebrospinal fluid cell count were associated with increased shunt failure.

Researchers ultimately determined that the most important predictor for hydrocephalus was the need for DHC. While age did not play a role in the non-DHC cohort, younger patients who had DHC were more likely to develop PTH.

In conclusion, post-traumatic hydrocephalus is a serious complication that has the potential to occur after neurotrauma, especially for patients who underwent a decompressive hemicraniectomy and are younger in age. It is believed that a more timely diagnosis of PTH combined with the appropriate shunt surgery can help improve overall patient outcomes.

Read the fully study here.