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Background <p>Post-traumatic hydrocephalus (PTH) is a common complication following decompressive craniectomy for traumatic brain injury (TBI), occurring in 7–36% of patients. Despite its significant impact on recovery and long-term outcomes, the relative contribution of pre-operative, intra-operative, and post-operative factors to PTH development remains incompletely understood.</p> Objective <p>To identify and quantify independent risk factors for PTH following decompressive craniectomy and develop a clinically applicable risk stratification framework.</p> Methods <p>A retrospective cohort analysis of 142 consecutive patients who underwent decompressive craniectomy for TBI was conducted. The primary outcome was radiologically defined hydrocephalus. Pre-operative, intra-operative, and post-operative clinical and radiological variables were analysed using univariable and multivariable logistic regression. Model performance was assessed using area under the receiver operating characteristic curve (AUC), Hosmer–Lemeshow goodness-of-fit testing, and pseudo-R<sup>2</sup> values.</p> Results <p>Hydrocephalus developed in 43 patients (30.3%). Univariable analysis identified lower Glasgow Coma Scale (GCS) on arrival, post-operative interhemispheric hygroma, subdural hygroma, herniation, intraventricular haemorrhage, and pseudomeningocele as significant predictors (all P &lt; 0.01). Intraoperative surgical parameters showed no association with PTH. The final multivariable model identified two independent predictors: lower GCS on arrival (OR 0.88, 95% CI 0.79–0.99; P = 0.032) and post-operative interhemispheric hygroma (OR 4.89, 95% CI 1.95–12.28; P = 0.0007). The model demonstrated strong discrimination (AUC = 0.807) and excellent calibration (Hosmer–Lemeshow P = 0.69), with overall classification accuracy of 81.0%. GCS score of ≤ 8 on arrival was significantly associated with increased hydrocephalus risk in binary analysis (<i>P</i> = 0.007), whereas the same threshold at intubation was not significant.</p> Conclusions <p>Post-operative complications, particularly interhemispheric hygroma, are the strongest predictors of PTH following decompressive craniectomy, while surgical technique parameters show no significant association. These findings support the implementation of structured post-operative surveillance protocols to enable early detection and intervention in high-risk patients. A clinical risk assessment checklist incorporating these factors may improve prognostic accuracy and guide individualised management strategies.</p>

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The paradox of relief: how decompression sets the stage for hydrocephalus—a retrospective inquiry into its clinical determinants

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月22日

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  • Muhammad Daniyal,
  • Muhammad Samir Irfan Wasi,
  • David Davies,
  • Anna Podlasek

摘要

Background

Post-traumatic hydrocephalus (PTH) is a common complication following decompressive craniectomy for traumatic brain injury (TBI), occurring in 7–36% of patients. Despite its significant impact on recovery and long-term outcomes, the relative contribution of pre-operative, intra-operative, and post-operative factors to PTH development remains incompletely understood.

Objective

To identify and quantify independent risk factors for PTH following decompressive craniectomy and develop a clinically applicable risk stratification framework.

Methods

A retrospective cohort analysis of 142 consecutive patients who underwent decompressive craniectomy for TBI was conducted. The primary outcome was radiologically defined hydrocephalus. Pre-operative, intra-operative, and post-operative clinical and radiological variables were analysed using univariable and multivariable logistic regression. Model performance was assessed using area under the receiver operating characteristic curve (AUC), Hosmer–Lemeshow goodness-of-fit testing, and pseudo-R2 values.

Results

Hydrocephalus developed in 43 patients (30.3%). Univariable analysis identified lower Glasgow Coma Scale (GCS) on arrival, post-operative interhemispheric hygroma, subdural hygroma, herniation, intraventricular haemorrhage, and pseudomeningocele as significant predictors (all P < 0.01). Intraoperative surgical parameters showed no association with PTH. The final multivariable model identified two independent predictors: lower GCS on arrival (OR 0.88, 95% CI 0.79–0.99; P = 0.032) and post-operative interhemispheric hygroma (OR 4.89, 95% CI 1.95–12.28; P = 0.0007). The model demonstrated strong discrimination (AUC = 0.807) and excellent calibration (Hosmer–Lemeshow P = 0.69), with overall classification accuracy of 81.0%. GCS score of ≤ 8 on arrival was significantly associated with increased hydrocephalus risk in binary analysis (P = 0.007), whereas the same threshold at intubation was not significant.

Conclusions

Post-operative complications, particularly interhemispheric hygroma, are the strongest predictors of PTH following decompressive craniectomy, while surgical technique parameters show no significant association. These findings support the implementation of structured post-operative surveillance protocols to enable early detection and intervention in high-risk patients. A clinical risk assessment checklist incorporating these factors may improve prognostic accuracy and guide individualised management strategies.