Effect Of Simple Cranioplasty On Hydrocephalus After Decompressive Craniectomy

Objective: To investigate the effect of simple cranioplasty on hydrocephalus after decompressive craniectomy.Methods: From September 2017 to September 2020,112 patients(male71,female 41)treated in neurosurgery at our hospital were selected for a two-way cohort study.According to preoperative hydrocephalus,it was divided into observation group(40 cases with hydrocephalus)and control group(72 cases without hydrocephalus).Preoperative data including sex,age,etiology,defecting time,defect location,Barthel index,imaging information(ventricular size,hydrocephalus,extracranial effusion,etc.),calculation of Evan’s index,frontal angle width and defect area of interventricular dimension.The skull repair was performed according to the unified procedure,and the ostoperative complications,Barthel index,Evan’s index and frontal angle width were recorded according to the follow-up riteria.Finally,preoperative status,complications,ventricular changes and Barthel scores of the two groups were compared,and the prognostic indexes of hydrocephalus patients were analyzed.Results: Age,defect area and number of aneurysm patients in observation group were significantly higher than those in control group(P<0.05).The incidence of complications after cranioplasty was 29.5%(33 of112),complication types were epilepsy(19 cases,17%),hydrocephalus(12cases,10.7%),extracranial hematoma(5 cases,4.5%),intracerebral hematoma(4 cases,3.6%),subdural effusion(3 cases,2.7%)and severe brain swelling/death(1 case,0.89%).There was no significant difference in the incidence of complications between two grops(P>0.05).The postoperative frontal angle width of the control group was significantly larger than preoperative(P<0.05),but there was no significant difference in the observation group(P>0.05).The proportion of ventricles shrinking in the hydronephrosis group was significantly higher than that in the control group(P<0.05),but the degree of reduction seemed meaningless(Evan’s index :0.38±0.06 vs 0.33,P<0.05).Ventricles of the control group were enlarged but did not reach the level of hydrocephalus(Evan’s index :0.30 vs0.33,P<0.05).Barthel scores of control group were significantly higher than hydronephrosis group before and after operation(P<0.05),but all pantients’ score were significantly higher than preoperative(P<0.05),there was no significant difference between the two groups of improvement rate(P>0.05).Correlation analysis showed that there was no significant relationship between ventricular changes and score improvement between the two groups(P>0.05).Analysis of sex,age,preoperative status,side of defect,cause of craniectomy,defect time,defect area,complications and other factors,found that the above factors did not affect the surgical prognosis of cranioplasty in patients with hydrocephalus(P>0.05).Conclusion: 1.There was no significant difference in the incidence of complications between hydrocephalus and non-hydrocephalus patients.2.The quality of life and neurofunction of most hydrocephalus patients can be improved by simple skull repair.3.Ventricular changes can not reflect the improvement of patients after cranioplasty.