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<p>The effectiveness of surgical intervention for hydrocephalus in patients with prolonged disorders of consciousness (pDoC) remains controversial. To investigate the impact of ventriculoperitoneal shunt (VPS) on secondary hydrocephalus patients with pDoC following traumatic brain injury (TBI) and intracranial hemorrhage (ICH). We conducted a retrospective matched cohort study based on age, duration and state of consciousness. Patients in the vegetative state/minimally conscious state (VS/MCS) with secondary hydrocephalus due to TBI/ICH who underwent VPS and non-VPS patients who served as a matched control group from March 2020 to September 2024 were included. Clinical data, surgical outcomes and related complications were compared between groups using descriptive/bivariate analyses. A PubMed review of the literature published between 2000 and 2024 was performed. Forty-seven patients in the VPS group were identified and matched to 47 patients in the non-VPS group during 6-month follow-up. Overall, 63.8% (30/47) of patients with pDoC improved consciousness after VPS. However, consciousness improved without intervention in only 6.4% (3/47) of patients with pDoC. Compared with the non-VPS group, the VPS group had a significantly better state of consciousness, periventricular edema and hypertonia (<i>p</i> = 0.037, <i>p</i> &lt; 0.001 and <i>p</i> &lt; 0.001, respectively), and the VPS group had significantly improved Evan’s index, JFK coma recovery scale–revised (CRS-R) and Glasgow Coma Scale (GCS) (<i>p</i> &lt; 0.001). VPS was significantly more effective in improving consciousness at a duration of 1–3 months, moderate-to-severe periventricular edema and high-pressure hydrocephalus. There was no difference in the incidence of complications between patients who underwent VPS related to complications in the patients with pDoC group and those in the conscious group (<i>p</i> = 0.963). There was no difference in the incidence of complications in the patients with pDoC between the VPS group and the non-VPS group (<i>p</i> = 0.930). In literature review, improvements in consciousness were observed in 60.6% (134/221) of patients with pDoC after the intervention. Improvement in consciousness was observed in only 6.9% (2/29) of patients with pDoC in the non-VPS group. VPS can improve patients with pDoC levels to some extent, and shunt did not reduce the overall complications of patients with pDoC.</p>

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Outcomes following shunt for secondary hydrocephalus in patients with prolonged disorders of consciousness: a matched cohort study

  • 期刊论文

  • 发表日期：

    2026年3月19日

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  • Qilong Tian,
  • Bo Tian,
  • Kailu Li,
  • Le Zou,
  • Dayun Feng,
  • Lijun Bai,
  • Yan Qu,
  • Qing Cai

摘要

The effectiveness of surgical intervention for hydrocephalus in patients with prolonged disorders of consciousness (pDoC) remains controversial. To investigate the impact of ventriculoperitoneal shunt (VPS) on secondary hydrocephalus patients with pDoC following traumatic brain injury (TBI) and intracranial hemorrhage (ICH). We conducted a retrospective matched cohort study based on age, duration and state of consciousness. Patients in the vegetative state/minimally conscious state (VS/MCS) with secondary hydrocephalus due to TBI/ICH who underwent VPS and non-VPS patients who served as a matched control group from March 2020 to September 2024 were included. Clinical data, surgical outcomes and related complications were compared between groups using descriptive/bivariate analyses. A PubMed review of the literature published between 2000 and 2024 was performed. Forty-seven patients in the VPS group were identified and matched to 47 patients in the non-VPS group during 6-month follow-up. Overall, 63.8% (30/47) of patients with pDoC improved consciousness after VPS. However, consciousness improved without intervention in only 6.4% (3/47) of patients with pDoC. Compared with the non-VPS group, the VPS group had a significantly better state of consciousness, periventricular edema and hypertonia (p = 0.037, p < 0.001 and p < 0.001, respectively), and the VPS group had significantly improved Evan’s index, JFK coma recovery scale–revised (CRS-R) and Glasgow Coma Scale (GCS) (p < 0.001). VPS was significantly more effective in improving consciousness at a duration of 1–3 months, moderate-to-severe periventricular edema and high-pressure hydrocephalus. There was no difference in the incidence of complications between patients who underwent VPS related to complications in the patients with pDoC group and those in the conscious group (p = 0.963). There was no difference in the incidence of complications in the patients with pDoC between the VPS group and the non-VPS group (p = 0.930). In literature review, improvements in consciousness were observed in 60.6% (134/221) of patients with pDoC after the intervention. Improvement in consciousness was observed in only 6.9% (2/29) of patients with pDoC in the non-VPS group. VPS can improve patients with pDoC levels to some extent, and shunt did not reduce the overall complications of patients with pDoC.