Analysis Of The Influencing Factors Of Operation Timing On The Outcome And Risk Factors Of Traumatic Hydrocephalus

Objective: Traumatic hydrocephalus（Post-traumatic Hydrocephalus,PTH）is the abnormal accumulation of cerebrospinal fluid（Cerebrospinal Fluid,CSF）in the ventricular system caused by the interruption of cerebrospinal fluid circulation and reabsorption.It is a serious complication in patients with traumatic craniocerebral injury（traumatic brain injuries,TBI）.The timing of shunt surgery is particularly important in the treatment of traumatic hydrocephalus.The purpose of this study is to analyze the clinical characteristics and risk factors associated with PTH,and to explore the impact of the timing of surgical treatment on the outcome of patients,in order to more accurately diagnose and intervene this kind of patients.Methods: The data of 641 patients with TBI in the TBI database of Department of Neurosurgery,Anhui Hospital of traditional Chinese Medicine from January 2015 to December 2017 were retrospectively analyzed.The inclusion criteria were as follows:age > 16 years old,imaging diagnosis of intracranial abnormalities related to trauma,loss of consciousness > 30 min,Glasgow coma score（Glasgow coma scale,GCS）< 13.The exclusion criteria were as follows: age ≤ 16 years old,loss of consciousness <30min,no obvious abnormality in imaging examination,GCS ≥ 13,incomplete main information or loss of target variables.According to the imaging data,all the patients were divided into two groups.The demographic characteristics,trauma mechanism and clinical status of 257 patients during acute hospitalization and rehabilitation hospitalization were recorded.The basic clinical features included GCS score,post-traumatic amnesia（post-traumatic amnesia,PTA）score,type of injury and length of hospital stay from acute to convalescent stage.In-hospital management includes craniotomy,bone flap decompression,and cerebrospinal fluid drainage.The timing and related complications of ventriculoperitoneal shunt（ventriculoperitoneal shunt,VPS）placement were recorded from electronic medical records.The functional status of the subjects was evaluated by the functional Independence scale（functional independent measures,FIM）,the appearance and duration of PTA and the days of hospitalization during the rehabilitation period.The patients were assessed by FIM on admission and discharge.Galveston orientation and amnesia test（Galveston orientation and amnesia test,GOAT）was used to evaluate PTA,and PTA duration data were extracted from emergency or convalescent hospital records.PTA data records were divided into two categories of variables（presence or absence before discharge）and continuous variables（duration of amnesia）.For the patients without PTA during hospitalization,the duration was recorded as the days from injury to discharge from the rehabilitation period.The clinical epidemiological data of the two groups were collected and analyzed by statistical methods;and the patients were further divided into early shunt group and late shunt group.By comparing the curative effect of the two groups,the impact of shunt timing on the outcome of treatment was evaluated.Results:（1）the patients in PTH group had more imaging evidence of intracranial space occupying（P < 0.001）,more patients underwent surgical treatment（P < 0.001）,and the hospitalization time in acute stage was significantly prolonged（P < 0.001）.（2）in PTH patients undergoing ventriculoperitoneal shunt（VPS）,early shunt was associated with better treatment outcome,and could independently predict higher functional independence scale（FIM）score（P < 0.001）and shorter duration of post-traumatic amnesia（PTA）（P < 0.027）.（3）in multivariate analysis,the occurrence of PTH was an independent predictor of long-term PTA and low FIM score at discharge.（4）the GCS motor score of the patients who later developed into PTH was less than 6 when they were admitted to the emergency department,and the interval from acute hospitalization to convalescent hospitalization was longer.（5）with the occurrence of PTH,the duration of PTA was prolonged by an average of 51 days,and the FIM score decreased by 29 points.Conclusions: TBI patients with early intracranial space occupying manifestations and craniotomy decompression are more likely to progress to PTH;patients complicated with traumatic hydrocephalus to predict worse outcomes and lower functional scores,and to prolong the duration of PTA.In PTH patients who received shunt treatment,early shunt surgery predicted a better outcome.These results suggest that it is necessary to observe and guard against the occurrence of PTH in patients with TBI combined with risk factors in the course of clinical treatment.