gms | German Medical Science

Objective: The primary objective of this retrospective study was to compare the results of patients after hemicraniectomy with simultaneous hydrocephalus. We compared three groups of patients, according to the sequence of the two surgeries. Our focus was to find ways to further improve the outcome of these already very delicate patient population.

Method: A total of 179 patients received a cranioplasty after decompressive hemicraniectomy between 2005 and 2013 in our institution. 42 of those patients additionally developed hydrocephalus. 19 patients received shunting followed by cranioplasty (group 1), 16 patients received cranioplasty followed by shunting (group 2) and 7 patients were operated simultaneously (group 3). Primary outcome parameters were complication rate (early: <30 days after surgery; late >30 days after surgery), the number of revision surgeries per patient and mortality.

Results: The early complication rates were 32%, 50% and 57% between groups 1-3. Concerning the late complications we found 47% in group 1, 31% in group 2 and 14% in group 3. Average number of revision surgeries in the three groups were 1,3 ; 1,4 and 0,6 respectively. In group 1 and 3 we had one patient in each group that died.

Conclusions: The surgical treatment of patients after hemicraniectomy that additionally develop hydrocephalus carries a significant risk for complications and the need for regular surgical revision surgeries. The simultaneous cranioplasty and VP shunt implantation shows a higher early complication rate but seems to be superior when it comes to the late complication rate and the number of revision surgeries compared to the other two groups. Regarding mortality there seems to be no difference between the groups.