gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Diagnosis and treatment of post-traumatic hydrocephalus in early rehabilitation

Diagnostik und Behandlung des posttraumatischen Hydrozephalus in der Frührehabilitation

Meeting Abstract

  • corresponding author Rainer Joachim Strege - Abteilung für Neurochirurgie, Stereotaxie und Frührehabilitation, Klinikum Plau am See, Plau am See
  • P. Schumann - Abteilung für Neurochirurgie, Stereotaxie und Frührehabilitation, Klinikum Plau am See, Plau am See
  • K. Terstegge - Abteilung für Neuroradiologie, Klinikum Plau am See, Plau am See
  • E. Donauer - Abteilung für Neurochirurgie, Stereotaxie und Frührehabilitation, Klinikum Plau am See, Plau am See

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 13.133

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0417.shtml

Veröffentlicht: 23. April 2004

© 2004 Strege et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Diagnosis and proper treatment of post-traumatic hydrocephalus (PTH) are important issues in the management of patients after severe head injury (SHI), especially in the early rehabilitation. Correct diagnosis of PTH may be difficult. We report our experience with PTH in early rehabilitation over a 5-year period.

Methods

The charts of all early rehabilitation patients between 6/1998 and 5/2003 were retrospectively analysed for diagnosis and treatment of PTH with special focus on the outcome.

Results

Fourteen (11.6%) of 120 SHI patients (10 men, 4 women) had ventriculomegaly interpreted as PTH and treated by ventriculo-peritoneal shunting. Besides two patients who were shunted elsewhere before being transferred to our hospital, the patients had non-programmable Hakim valves (NMT Neurosciences) in 11 cases and the HAKIMTM programmable valve (Codman) in one. The median time point of diagnosis was 38.5 (range: 15-467) days after SHI and the time point of shunting 55 (range: 20-489) days. The time point of shunting was delayed by intercurrent infections in 7 cases. Post-operative complications were seen in 3 of 12 patients (1x sepsis prompting shunt revision, 1x hygroma inducing temporary shunt ligation and 1x slit ventricles resulting in implantation of a shunt assistant). Post-operative neurological improvement was seen in 9 of 12 (75%) patients being shunted in our hospital and corresponded to GCS scores. The median GCS score at the time of PTH diagnosis was 7 (range: 4-13) and 11 (range: 6-15) at discharge 0.5-9 months (median: 3 months) after shunting. Unchanged neurological condition was observed in 3 of 12 cases. Morphological CCT- or MRI-signs of decreasing hydrocephalus were seen in 11 of 12 patients and did not correlate very well with their neurological rehabilitation. Clinical improvement after spinal tap test proved to be the best predictor of a favourable outcome.

Conclusions

On the basis of our data, PTH may be encountered in more than 10% of early rehabilitation patients after SHI. Precise clinical observation facilitates correct diagnosis of PTH by CT imaging in combination with spinal tap testing so that surgical shunting enables neurological improvement in the majority of these cases.