Multiplicity And Prevention For Patients With Secondary Hydrocephalus To Severe Traumatic Brain Injury After Surgery

Objective: To investigate the factors for secondary hydrocephalus to sever traumatic brain injury after surgery, providing a new theory and guideline for clinical early prevention and treatment for hydrocephalus.Materials and methods:A clinic study was carried out in 144 patients with severe traumatic brain injury who were admitted to our hospital from 2010 June to 2013 December. The relationships between secondary hydrocephalus and factors including of age, gender, the pre/postoperative GCS score, the injury site, the pre/postoperative intraventricularhemorrhage(IVH), the aqueduct of midbrain and cisterna?s change, postoperative complicated with large area-cerebralinfarction, postoperative intracranial infection, postoperativecerebral pressure, lumbar puncture and early lumbar puncture( LP) were analyzed usingLogistic multi-factor regression,to investigate the influencing factors of hydrocephalus after surgery.Results:The results showed that patients with low GCS scoreduring perioperative period(Ppre=0.041;Ppost=0.039), IVH(Ppre=0.027;Ppost=0.039), the injury site in the skull base(P=0.042), unclear structures of the aqueduct and cisterna(Ppre=0.000;Ppost=0.000), postoperative complicated with large area-cerebralinfarction(P=0.031), postoperative intracranial infection(P=0.027)were the risk factors, but postoperativedecrease intracranial pressure( ICP)( P = 0.001) and postoperative LP( P = 0.000) were protection factors.Compared with non-LP group, postoperative early LP could reduce the incidence of acute hydrocephalus(P=0.026) and chronic hydrocephalus(P=0.033), thedifference had statistical significance.Conclusion:The pathogenesis of postoperative hydrocephalus on patients with severebrain injuryis complex; it not only follows the theory of cerebrospinal fluid circulation pathway(CFCPT), but also observed the StarlingLaw and even other factors. The patients with severe craniocerebral injury who have the low GCS score of perioperative period, preoperative and postoperative intraventricularhematocele, injury to the skull base, unclear structures of the aqueduct and cisterna, large area cerebral infarction of postoperative and postoperative intracranial infection all of them can easily lead to the formation of secondary hydrocephalus.Timely and effectivecontrol the development of cerebraledema, decrease ICP, discharge cerebrospinal fluid(CSF) could reduce the incidence of hydrocephalus in patients with severe traumatic brain injury.