Analysis of the treatment strategies and surgical complications of hydrocephalus after decompressive craniectomy

Objectives To investigate the reasonable operation time and operation approaches of the hydrocephalus treatment after decompressive craniectomy and to count its complication characteristics. Methods From January 2009 to February 2015, the clinical data of 54 patients treated with cranioplasty and ventricular peritoneal (V-P) shunt at the same time (n=21) or different time (n=33) at the Department of Neurosurgery, Shandong Jiaotong Hospital and the Emergency Surgery, Qilu Hospital of Shandong University were analyzed retrospectively. The operation time of both procedures and the operation related complications were analyzed and discussed. Results The surgical complication rate was 32% (17/54). The occurrence rates of complications of cranioplasty and V-P shunt groups over the same period were higher than those of the staging operation group (57% vs. 15%; P<0.05). The incidence of postoperative infection of the synchronous operation group was significantly higher than that of the staging operation group (P<0.02). The incidence of postoperative complication in patients with flap bulging was higher than that in patients with flap depression (40% vs. 16%, P<0.05). There were no statistical significance in the effects of successively order, skull defect area, and degree of hydrocephalus on complications of the cranioplasty and V-P shunt between the 2 groups, however, 13 patients did not treated with V-P shunt because of their hydrocephalus were improved significantly after the first cranioplasty. Conclusions Because of its lower incidence of complications, the staging cranioplasty and V-P shunt might be more beneficial to the treatment of patients, especially for those with obvious flap bulging. Because the order of 2 procedures did not have any effect on postoperative complications and no need to perform V-P shunt after partial cranioplasty, therefore, it was recommended that patients without flap bulging should conduct cranioplasty first. Key words: Decompression, Surgery; Hydrocephalus; Neurosurgical procedures; Postoperative complications