Management of hydrocephalus after decompressive craniectomy.

AIM We set out to investigate the optimal timing for shunt placement in patients with hydrocephalus after decompressive craniectomy (DC). MATERIAL AND METHODS We studied 63 consecutive patients that underwent DC because of traumatic brain injury, middle cerebral artery infarct or intracerebral hemorrhage. Hydrocephalus was diagnosed in 23/63 patients. The 23 patients were divided into two groups. The first group (A) consisted of 11 patients in whom a ventriculoperitoneal shunt was placed simultaneously or before cranioplasty. In the second group (B) of 12 patients, we performed cranioplasty and a ventriculostomy with monitoring of intracranial pressure was placed simultaneously. After 3 to 5 days, a ventriculoperitoneal shunt was placed with the most appropriate opening pressure. RESULTS In group A, nine out of the eleven patients experienced complications, mainly hygromas or hematomas that required reoperation. In group B, none of the patients was reoperated. The use of programmable valves allowed for non-invasive revision of the opening pressure when required. CONCLUSION Cranioplasty and ventriculostomy followed by a second stage placement of a ventriculoperitoneal shunt are associated with fewer complications in the treatment of hydrocephalus after DC.