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- Title
Theco-peritoneal shunt for post-traumatic hydrocephalus -- A valuable adjunct?
- Authors
Phalak, Manoj; Agrawal, Deepak; Dawar, Pankaj; Anil Kumar Kothiwala; Singh, Pankaj K.; Bhawani Shankar Sharma
- Abstract
Introduction: Majority of patients undergoing decompressive craniectomy (DC) for traumatic brain injury may develop post-traumatic hydrocephalus (PTH). This remains a challenge to manage as most patients are tracheotomised and run high risk of shunt infection and malfunction following VP shunt. Theco-peritoneal shunt (TP shunt) may be an attractive alternative in this scenario. Aims & objectives: To assess the role of TP shunt in PTH with respect to the patient population, complications & clinical outcome in TBI. Materials & methods: In this retrospective study over 32 months (September 2009-April 2012) records of all patients of TBI who underwent TP shunt at a level 1 trauma centre were analysed. Clinical, radiological and follow up data were reviewed in all cases. Observations & results: A total of 22 TP shunts were done in the study period. Of these 77.2% patients had severe head injury, 18.2% had moderate head injury and 4.5% had mild head injury. The most common initial CT findings were acute SDH in 86.4% and contusions in 81.8% of the patients. 95.5% patients underwent DC at initial admission. Most common presentations of PTH were bulging flap (95.5%), vomiting (72.7%) and headache (63.3%). 91.9% of the patient had tracheostomy in situ. Of these, 5 patients (25%) had positive tracheal cultures and six (27.3%) patients had scalp bedsore/flap infection prior to TP shunt. Following TP shunt, 77.3% patients showed clinical &/or radiological improvement. Shunt infection and revision rates were 0% and 22.7% respectively. Conclusions: PTH in patients with TBI needs a holistic approach in view of scalp bed sores, tracheostomy and altered ventricular anatomy. TP shunt is a safe, minimally morbid procedure which should be considered as an attractive alternative to VP shunt in patients with PTH.
- Subjects
HYDROCEPHALUS; BRAIN injuries; PATIENTS; RADIOLOGY; VOMITING
- Publication
Indian Journal of Neurotrauma, 2013, Vol 10, Issue 2, p86
- ISSN
0973-0508
- Publication type
Article
- DOI
10.1016/j.ijnt.2013.10.005