Posttraumatic Hydrocephalus

  • Jason Milton
  • Jeffrey R. Leonard


Posttraumatic hydrocephalus is seen in 4% of patients that sustain a severe traumatic brain injury (TBI). Understanding the pathophysiology and diagnostic evaluation of posttraumatic hydrocephalus allows providers that do not routinely manage chronic hydrocephalus to effectively manage this condition as expected sequelae of traumatic brain injury. Understanding the appropriate diagnostic evaluation as well as medical and surgical management is key, as there are some differences in the pathophysiology and evaluation of posttraumatic hydrocephalus and chronic hydrocephalus. Outcomes after shunt implantation in posttraumatic hydrocephalus show that greater than 50% of patients will have a clear benefit after CSF diversion (Tribl G, Oder W, Brain Inj 14:345–54, 2000).


Posttraumatic hydrocephalus Traumatic brain injury Normal pressure hydrocephalus Adjustable valve Programmable valve 


  1. 1.
    Anile C, De Bonis P, Mangiola A, Mannino S, Santini P. A new method of estimating intracranial elastance. Interdis Neuros. 2014;1:26–30.Google Scholar
  2. 2.
    Bergsneider M. Management of hydrocephalus with programmable valves after traumatic brain injury and subarachnoid hemorrhage. Curr Opin Neurol. 2000;13(6):661–4.CrossRefGoogle Scholar
  3. 3.
    Chang CC, Asada H, Mimura T, Suzuki S. A prospective study of cerebral blood flow and cerebrovascular reactivity to acetazolamide in 162 patients with idiopathic normal-pressure hydrocephalus. J Neurosurg. 2009;111(3):610–7.CrossRefGoogle Scholar
  4. 4.
    Chang CC, Kuwana N, Ito S, Ikegami T. Impairment of cerebrovascular reactivity to acetazolamide in patients with normal pressure hydrocephalus. Nucl Med Commun. 2000;21(2):139–41.CrossRefGoogle Scholar
  5. 5.
    Chen Z, Gao C, Hua Y, Keep RF, Muraszko K, Xi G. Role of iron in brain injury after intraventricular hemorrhage. Stroke. 2011;42(2):465–70.CrossRefGoogle Scholar
  6. 6.
    Dandy WE, Blackfan KD. Internal hydrocephalus: an experimental, clinical, and pathological study. Am J Dis Child. 1914;8:406.CrossRefGoogle Scholar
  7. 7.
    De Bonis P, Mangiola A, Pompucci A, Formisano R, Mattogno P, Anile C. CSF dynamics analysis in patients with post-traumatic ventriculomegaly. Clin Neurol Neurosurg. 2013;115(1):49–53.CrossRefGoogle Scholar
  8. 8.
    De Bonis P, Tamburrini G, Mangiola A, Pompucci A, Mattogno PP, Porso M, Anile C. Post-traumatic hydrocephalus is a contraindication for endoscopic third-ventriculostomy: isn’t it? Clin Neurol Neurosurg. 2013;115(1):9–12.CrossRefGoogle Scholar
  9. 9.
    Fotakopoulos G, Tsianaka E, Siasios G, Vagkopoulos K, Fountas K. Posttraumatic hydrocephalus after decompressive craniectomy in 126 patients with severe traumatic brain injury. J Neurol Surg A Cent Eur Neurosurg. 2016;77(2):88–92.PubMedGoogle Scholar
  10. 10.
    Guyot LL, Michael DB. Post-traumatic hydrocephalus. Neurol Res. 2000;22(1):25–8.CrossRefGoogle Scholar
  11. 11.
    Heo J, Park SQ, Cho SJ, Chang JC, Park HK. Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures. J Neurosurg. 2014;121(2):313–8.CrossRefGoogle Scholar
  12. 12.
    Jeong SH, Wang US, Kim SW, Ha SW, Kim JK. Symptomatic epidural fluid collection following cranioplasty after decompressive craniectomy for traumatic brain injury. Korean J Neurotrauma. 2016;12(1):6–10.CrossRefGoogle Scholar
  13. 13.
    Kaen A, Jimenez-Roldan L, Alday R, Gomez PA, Lagares A, Alén JF, Lobato RD. Interhemispheric hygroma after decompressive craniectomy: does it predict posttraumatic hydrocephalus? J Neurosurg. 2010;113(6):1287–93.CrossRefGoogle Scholar
  14. 14.
    Katz RT, Brander V, Sahgal V. Updates on the diagnosis and management of posttraumatic hydrocephalus. Am J Phys Med Rehabil. 1989;68(2):91–6.CrossRefGoogle Scholar
  15. 15.
    Kim KH, Yeo IS, Yi JS, Lee HJ, Yang JH, Lee IW. A pressure adjustment protocol for programmable valves. J Korean Neurosurg Soc. 2009;46(4):370–7.CrossRefGoogle Scholar
  16. 16.
    Kim SW, Lee SM, Shin H. Clinical analysis of post-traumatic hydrocephalus. J Korean Neurosurg Soc. 2005;38:211–4.Google Scholar
  17. 17.
    Leborgne JM, Sheldon JJ, Goldstein MS, Smoak WM 3rd, Serafini AN. Differential diagnosis between normal pressure hydrocephalus and cerebral atrophy on computed tomography. Rev Interam Radiol. 1979;4(2):75–8.PubMedGoogle Scholar
  18. 18.
    Lewis A, Taylor KW. Prediction of ventriculoperitoneal shunt placement based on type of failure during external ventricular drain wean. Clin Neurol Neurosurg. 2014;125:109–13.CrossRefGoogle Scholar
  19. 19.
    Mazzini L, Campini R, Angelino E, et al. Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome. Arch Phys Med Rehabil. 2003;84(11):1637–41.CrossRefGoogle Scholar
  20. 20.
    Meyer RM, Morton RP, Abecassis IJ, Barber JK, Emerson SN, Nerva JD, et al. Risk of complication with simultaneous cranioplasty and placement of ventriculoperitoneal shunt. World Neurosurg. 2017;107:830–3.CrossRefGoogle Scholar
  21. 21.
    Meyers C, Levin H, Eisenberg H. Early versus late ventricular enlargement following closed head injury. J Neurol Neurosurg Psychiatry. 1983;46:1092–7.CrossRefGoogle Scholar
  22. 22.
    Moon JW, Hyun DK. Decompressive craniectomy in traumatic brain injury: a review article. Korean J Neurotrauma. 2017;13(1):1–8.CrossRefGoogle Scholar
  23. 23.
    Narayan RJ, Gokaslan ZL, Bontke CF. Neurologic sequelae of head injury. In: Rosenthal M, editor. Rehabilitation of the adult and child with traumatic brain injury. 2nd ed. Philadelphia: Davis; 1990. p. 94–106.Google Scholar
  24. 24.
    Rahme R, Weil AG, Sabbagh M, Moumdjian R, Bouthillier A, Bojanowski MW. Decompressive craniectomy is not an independent risk factor for communicating hydrocephalus in patients with increased intracranial pressure. Neurosurgery. 2010;67(3):675.CrossRefGoogle Scholar
  25. 25.
    Raz E, Jensen JH, Ge Y, Babb JS, Miles L, Reaume J, et al. Brain iron quantification in mild traumatic brain injury: a magnetic field correlation study. AJNR Am J Neuroradiol. 2011;32(10):1851–6.CrossRefGoogle Scholar
  26. 26.
    Reddy GK, Bollam P, Shi R, Guthikonda B, Nanda A. Management of adult hydrocephalus with ventriculoperitoneal shunts: long-term single-institution experience. Neurosurgery. 2011;69(4):774–80. discussion 780–1.CrossRefGoogle Scholar
  27. 27.
    Schuss P, Borger V, Güresir Á, Vatter H, Güresir E. Cranioplasty and ventriculoperitoneal shunt placement after decompressive craniectomy: staged surgery is associated with fewer postoperative complications. World Neurosurg. 2015;84(4):1051–4.CrossRefGoogle Scholar
  28. 28.
    Tribl G, Oder W. Outcome after shunt implantation in severe head injury with post-traumatic hydrocephalus. Brain Inj. 2000;14(4):345–54.CrossRefGoogle Scholar
  29. 29.
    Vedantam A, Yamal JM, Hwang H, Robertson CS, Gopinath SP. Factors associated with shunt-dependent hydrocephalus after decompressive craniectomy for traumatic brain injury. J Neurosurg. 2017;16:1–6.Google Scholar
  30. 30.
    Weintraub AH, Gerber DJ, Kowalski RG. Posttraumatic hydrocephalus as a confounding influence on brain injury rehabilitation: incidence, clinical characteristics, and outcomes. Arch Phys Med Rehabil. 2017;98(2):312–9.CrossRefGoogle Scholar
  31. 31.
    Wen L, Wan S, Zhan RY, Li G, Gong JB, Liu WG, et al. Shunt implantation in a special sub-group of post-traumatic hydrocephalus--patients have normal intracranial pressure without clinical representations of hydrocephalus. Brain Inj. 2009;23(1):61–4.CrossRefGoogle Scholar
  32. 32.
    Yang XF, Wang H, Wen L, Huang X, Li G, Gong JB. The safety of simultaneous cranioplasty and shunt implantation. Brain Inj. 2017;12:1–5.Google Scholar
  33. 33.
    Zhao J, Chen Z, Xi G, Keep RF, Hua Y. Deferoxamine attenuates acute hydrocephalus after traumatic brain injury in rats. Transl Stroke Res. 2014;5(5):586–94.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryOhioHealthColumbusUSA
  2. 2.Nationwide Children’s Hospital, Department of NeurosurgeryThe Ohio State University College of MedicineColumbusUSA

Personalised recommendations