The Clinical Observation Of The VP Shunting On The Outcomes Of Patients With Normal Pressure Hydrocephalus After Decompressive Craniectomy

Objective Study the clinical overvation of the VP (Ventriculoperitoneal) shunting on the severe traumatic brain injury (STBI) patients with the normal pressure hydrocephalus (NPH) after decompressive craiectomy (DC) surgery.Methods All STBI patents with the NPH after DC in Department of Neurosurgery, the First Affiliated Hospital, Zhejiang University, dated from January January2011to Novenber2012were collected. According to the operation choice of V-P shunting, the patients were divided into shunting group or un-shunting group. The data including age, gender,the Glasgow Coma Scale(GCS) score after DC surgery, the consciousness, the time between DC surgery and VP shunting surgery, the lumber pressure, the hydrocephalus extent, complication after VP shunting were collected. We analyzed the Glasgow Outcome Scale (GOS) score and Modified Barthel Index(MBI) score of the two group during the18-month following upto figure out the improvement rate, improvement extent and the mortality rate. Results The mortality rate of the26patients in the shunting group was26.92%(18-month following up), and the mortality rate of the un-shunting group was25%, while the two groups have no significant difference. Among19survival patients in the shunting group,14(73.68%) obtained good outcome by showing higher improvement rate (P<0.05) compared to the un-shunting group (22.22%). The GOS score and MBI score at the point of the3、6、12、18-month after the shunting surgery of the shunting group were higher than the basic condition after the DC surgery (P<0.05), while the un-shunting group showed no significant difference (P>0.05). The18-month GOS and MBI scores of the shunting group were higher than that of the un-shunting group(P<0.05). The analysis of the subgroup of the coma or unconsciousness patients showed that the improvement rate of the shunting group was80%,which was higher than that of the un-shunting group (P<0.05). And the MBI score of the18-month after the DC surgery of the coma or unconsciousness patients in shunting group was higher than that of the un-shunting group (P<0.05)Conclusion For STBI patients with NPH after DC surgery, the VP shunting can not reduce the mortality rate, but showed higher rate of the improvement, long-term prognosis improvement and benefit the patients. To the coma or unconsciousness patients, who can not show the typical symptoms of the NPH, the VP shunting can raise the improvement rate and the improvement extent of the neurologic function.