Skip to main content

Advertisement

SpringerLink
Log in

Prognostic significance of subdural hygroma for post-traumatic hydrocephalus after decompressive craniectomy in the traumatic brain injury setting: a systematic review and meta-analysis

  • Review
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Post-traumatic hydrocephalus (PTH) is a potentially morbid sequela of decompressive craniectomy for traumatic brain injury (TBI). Subdural hygromas are commonly identified following decompressive craniectomy, but the clinical relevance and predictive relationship with PTH in this patient cohort is not completely understood. Survey of seven electronic databases from inception to June 2019 was conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Multivariate hazard ratios (HRs) for PTH by the presence of subdural hygroma were extracted and pooled by meta-analysis of proportions with random effects modeling. We systematically identified nine pertinent studies describing outcomes of 1010 TBI patients managed by decompressive craniectomy. Of the overall cohort, there were 211 (21%) females and median age was 37.5 years (range 33–53). On presentation, median Glasgow Coma Scale was 7 (range, 5–8). In sum, PTH was reported in 228/840 (27%) cases, and subdural hygroma was reported in 449/1010 (44%) cases across all studies. Pooling multivariate-derived HRs indicated that subdural hygroma was a significant, independent predictor of PTH (HR, 7.1; 95% CI, 3.3–15.1). The certainty of this association was deemed low due to heterogeneity concerns. The presence of subdural hygroma is associated with increased risk of PTH after decompressive craniectomy among TBI patients based on the current literature and may mandate closer clinical surveillance when detected. Prospective studies, including those of intracranial hydrodynamics following decompressive craniectomy in the setting of TBI, will better validate the certainty of these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM (2006) Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 104:469–479. https://doi.org/10.3171/jns.2006.104.4.469

    Article  PubMed  Google Scholar 

  2. De Bonis P, Pompucci A, Mangiola A, D'Alessandris QG, Rigante L, Anile C (2010) Decompressive craniectomy for the treatment of traumatic brain injury: does an age limit exist? J Neurosurg 112:1150–1153. https://doi.org/10.3171/2009.7.Jns09505

    Article  PubMed  Google Scholar 

  3. Guerra WK, Gaab MR, Dietz H, Mueller JU, Piek J, Fritsch MJ (1999) Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 90:187–196. https://doi.org/10.3171/jns.1999.90.2.0187

    Article  CAS  PubMed  Google Scholar 

  4. Honeybul S (2017) Decompressive craniectomy for severe traumatic brain injury reduces mortality but increases survival with severe disability. Evidence-based medicine 22:61. https://doi.org/10.1136/ebmed-2016-110616

    Article  PubMed  Google Scholar 

  5. Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ (2016) Trial of Decompressive Craniectomy for traumatic intracranial hypertension. N Engl J Med 375:1119–1130. https://doi.org/10.1056/NEJMoa1605215

    Article  PubMed  Google Scholar 

  6. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, Kossmann T, Ponsford J, Seppelt I, Reilly P, Wolfe R (2011) Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 364:1493–1502. https://doi.org/10.1056/NEJMoa1102077

    Article  CAS  PubMed  Google Scholar 

  7. De Bonis P, Sturiale CL, Anile C, Gaudino S, Mangiola A, Martucci M, Colosimo C, Rigante L, Pompucci A (2013) Decompressive craniectomy, interhemispheric hygroma and hydrocephalus: a timeline of events? Clin Neurol Neurosurg 115:1308–1312. https://doi.org/10.1016/j.clineuro.2012.12.011

    Article  PubMed  Google Scholar 

  8. Honeybul S, Ho KM (2012) Incidence and risk factors for post-traumatic hydrocephalus following decompressive craniectomy for intractable intracranial hypertension and evacuation of mass lesions. J Neurotrauma 29:1872–1878. https://doi.org/10.1089/neu.2012.2356

    Article  PubMed  Google Scholar 

  9. Kaen A, Jimenez-Roldan L, Alday R, Gomez PA, Lagares A, Alen JF, Lobato RD (2010) Interhemispheric hygroma after decompressive craniectomy: does it predict posttraumatic hydrocephalus? J Neurosurg 113:1287–1293. https://doi.org/10.3171/2010.4.Jns10132

    Article  PubMed  Google Scholar 

  10. Stiver SI (2009) Complications of decompressive craniectomy for traumatic brain injury. Neurosurg Focus 26:E7. https://doi.org/10.3171/2009.4.Focus0965

    Article  PubMed  Google Scholar 

  11. Beaumont A, Marmarou A (1999) Treatment of raised intracranial pressure following traumatic brain injury. Critical reviews in neurosurgery : CR 9:207–216

    Article  CAS  PubMed  Google Scholar 

  12. Di G, Zhang Y, Liu H, Jiang X, Liu Y, Yang K, Chen J, Liu H (2019) Postoperative complications influencing the long-term outcome of head-injured patients after decompressive craniectomy. Brain Behav:9. https://doi.org/10.1002/brb3.1179

  13. Evans WA Jr (1942) An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiatr 47:931–937. https://doi.org/10.1001/archneurpsyc.1942.02290060069004

    Article  Google Scholar 

  14. Huh PW, Yoo DS, Cho KS, Park CK, Kang SG, Park YS, Kim DS, Kim MC (2006) Diagnostic method for differentiating external hydrocephalus from simple subdural hygroma. J Neurosurg 105:65–70. https://doi.org/10.3171/jns.2006.105.1.65

    Article  PubMed  Google Scholar 

  15. Licata C, Cristofori L, Gambin R, Vivenza C (2001) Post-traumatic hydrocephalus/comment. J Neurosurg Sci 45:141

    CAS  PubMed  Google Scholar 

  16. Sun S, Zhou H, Ding ZZ, Shi H (2018) Risk factors associated with the outcome of post-traumatic hydrocephalus. Scandinavian journal of surgery : SJS : official organ for the Finnish surgical society and the Scandinavian surgical society:1457496918812210. doi:https://doi.org/10.1177/1457496918812210

  17. Eguchi S, Aihara Y, Hori T, Okada Y (2011) Postoperative extra-axial cerebrospinal fluid collection--its pathophysiology and clinical management. Pediatr Neurosurg 47:125–132. https://doi.org/10.1159/000330543

    Article  PubMed  Google Scholar 

  18. Yuan Q, Wu X, Yu J, Sun Y, Li Z, Du Z, Wu X, Zhou L, Hu J (2015) Subdural hygroma following decompressive craniectomy or non-decompressive craniectomy in patients with traumatic brain injury: clinical features and risk factors. Brain Inj 29:971–980. https://doi.org/10.3109/02699052.2015.1004760

    Article  PubMed  Google Scholar 

  19. Aarabi B, Hesdorffer DC, Simard JM, Ahn ES, Aresco C, Eisenberg HM, McCunn M, Scalea T (2009) Comparative study of decompressive craniectomy after mass lesion evacuation in severe head injury. Neurosurgery 64:927–939. https://doi.org/10.1227/01.NEU.0000341907.30831.D2

    Article  PubMed  Google Scholar 

  20. Choi I, Park HK, Chang JC, Cho SJ, Choi SK, Byun BJ (2008) Clinical factors for the development of posttraumatic hydrocephalus after decompressive craniectomy. Journal of Korean Neurosurgical Society 43:227–231. https://doi.org/10.3340/jkns.2008.43.5.227

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yang XF, Wen L, Gong JB, Zhan RY (2010) Subdural effusion secondary to decompressive craniectomy in patients with severe traumatic brain injury. Acta Neurochir 152:555–556. https://doi.org/10.1007/s00701-009-0475-2

    Article  CAS  PubMed  Google Scholar 

  22. Ki HJ, Lee H-J, Lee H-J, Yi J-S, Yang J-H, Lee I-W (2015) The Risk Factors for Hydrocephalus and Subdural Hygroma after Decompressive Craniectomy in Head Injured Patients. Journal of Korean Neurosurgical Society 58:254–261. https://doi.org/10.3340/jkns.2015.58.3.254

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Su T-M, Lan C-M, Lee T-H, Hsu S-W, Tsai N-W, Lu C-H (2019) Risk factors for the development of posttraumatic hydrocephalus after unilateral decompressive craniectomy in patients with traumatic brain injury. J Clin Neurosci 63:62–67. https://doi.org/10.1016/j.jocn.2019.02.006

    Article  PubMed  Google Scholar 

  24. Moher D, Liberati A, Tetzlaff J, Althman D (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1159/000320313

    Article  PubMed  PubMed Central  Google Scholar 

  25. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ : British Medical Journal 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  26. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer T, Varonen H, Vist GE, Williams JW Jr, Zaza S (2004) Grading quality of evidence and strength of recommendations. BMJ (Clinical research ed) 328:1490. https://doi.org/10.1136/bmj.328.7454.1490

    Article  Google Scholar 

  27. Phan K, Tian DH, Cao C, Black D, Yan TD (2015) Systematic review and meta-analysis: techniques and a guide for the academic surgeon. Ann Cardiothorac Surg 4:112–122. https://doi.org/10.3978/j.issn.2225-319X.2015.02.04

    Article  PubMed  PubMed Central  Google Scholar 

  28. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. Jama 283:2008–2012

    Article  CAS  PubMed  Google Scholar 

  29. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative S (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335:806–808. https://doi.org/10.1136/bmj.39335.541782.AD

    Article  Google Scholar 

  30. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

    Article  CAS  PubMed  Google Scholar 

  31. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed) 315:629–634

    Article  CAS  Google Scholar 

  32. Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463

    Article  CAS  PubMed  Google Scholar 

  33. Nasi D, Gladi M, Di Rienzo A, di Somma L, Moriconi E, Iacoangeli M, Dobran M (2018) Risk factors for post-traumatic hydrocephalus following decompressive craniectomy. Acta Neurochir 160:1691–1698. https://doi.org/10.1007/s00701-018-3639-0

    Article  PubMed  Google Scholar 

  34. Silva Neto AR, Valenca MM (2019) Transcalvarial brain herniation volume as a predictor of posttraumatic hydrocephalus after decompressive craniectomy. Clin Neurol Neurosurg 182:73–78. https://doi.org/10.1016/j.clineuro.2019.05.003

    Article  PubMed  Google Scholar 

  35. Vedantam A, Yamal J-M, Hwang H, Robertson CS, Gopinath SP (2018) Factors associated with shunt-dependent hydrocephalus after decompressive craniectomy for traumatic brain injury. J Neurosurg 128:1547–1552. https://doi.org/10.3171/2017.1.JNS162721

    Article  PubMed  Google Scholar 

  36. Kilincer C, Hamamcioglu MK (2010) Contralateral subdural effusion secondary to decompressive craniectomy: differences in patients with large hemispheric infarctions and traumatic brain injury. Medical principles and practice : international journal of the Kuwait University, Health Science Centre 19:499; author reply 500. doi:https://doi.org/10.1159/000320313

  37. Kowalski RG, Weintraub AH, Rubin BA, Gerber DJ, Olsen AJ (2018) Impact of timing of ventriculoperitoneal shunt placement on outcome in posttraumatic hydrocephalus. J Neurosurg:1–12. https://doi.org/10.3171/2017.7.Jns17555

  38. Schuss P, Borger V, Güresir Á, Vatter H, Güresir E (2015) Cranioplasty and Ventriculoperitoneal shunt placement after Decompressive Craniectomy: staged surgery is associated with fewer postoperative complications. World neurosurgery 84:1051–1054. https://doi.org/10.1016/j.wneu.2015.05.066

    Article  PubMed  Google Scholar 

  39. Honeybul S, Ho KM (2014) Decompressive craniectomy for severe traumatic brain injury: the relationship between surgical complications and the prediction of an unfavourable outcome. Injury 45:1332–1339. https://doi.org/10.1016/j.injury.2014.03.007

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Victor M. Lu, Lucas P. Carlstrom, Avital Perry, Christopher S. Graffeo & Fredric B. Meyer

  2. Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA

    Ricardo A. Domingo

  3. Department of Neurosurgery, University of Washington, Seattle, WA, USA

    Christopher C. Young

Authors
  1. Victor M. Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucas P. Carlstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Avital Perry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher S. Graffeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ricardo A. Domingo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christopher C. Young
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fredric B. Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Victor M. Lu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not required.

Informed consent

Not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 96 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lu, V.M., Carlstrom, L.P., Perry, A. et al. Prognostic significance of subdural hygroma for post-traumatic hydrocephalus after decompressive craniectomy in the traumatic brain injury setting: a systematic review and meta-analysis. Neurosurg Rev 44, 129–138 (2021). https://doi.org/10.1007/s10143-019-01223-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-019-01223-z

Keywords

Search

Navigation