Hydrocephalus Renders Ventricular or Subarachnoid Drainage as an Efficacies Cure for Decompressive Craniectomy-Induced Subdural Effusion After Traumatic Brain Injury.

Objective: Traumatic brain injury (TBI) patients with decompressive craniectomy (DC) frequently accompany the complication of secondary subdural effusion (SDE). In cases where cranioplasty is contraindicated, there are no clear-cut guidelines on surgical approaches for managing subdural effusion resulting from DC. Therefore, the authors conducted this study to compare different surgical procedures for patients with SDE in the context of contraindications for cranioplasty.

Methods: The clinical data of 59 patients with SDE following DC for TBI, who had contraindication of cranioplasty and received surgical treatment for SDE, were retrospectively selected from January 2010 to June 2023. The therapeutic efficacy of SDE was assessed based on the dynamic head CT scans performed within 1 month after surgery and the improvement of clinical symptoms. The authors compared the effects of ventricular or subarachnoid drainage (VSD, n = 33) and subdural drainage (SDD, n = 29), which, respectively, serve as CSF of control and direct diversion. Subgroup analysis also considered the presence or absence of hydrocephalus and the associated risk.

Results: This study found that VSD group exhibited superior therapeutic effects compared with SDD group. (75.8% versus 38.4%; P=0.004), with no significant difference in complication (P=0.543). Subgroup analysis indicates that patients with hydrocephalus who directly received VSD had better treatment effect than SDD (93.3% versus 11.1%, P<0.001), while for patients without hydrocephalus, there was no significant difference between the VSD group and the SDD group (61.1% versus 52.9%, P=0.442). Furthermore, in patients without hydrocephalus but at risk of hydrocephalus, the therapeutic effects of VSD were superior to those of SDD(100% versus 14%, P<0.001).

Conclusion: Our study reveal that VSD could be considered first compare to SDD for SDE patients with contraindications to cranioplastyt, especially when patients have a hydrocephalus or risk factors for hydrocephalus.