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JOURNAL OF NEUROSURGICAL SCIENCES

A Journal on Neurosurgery


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Journal of Neurosurgical Sciences 2017 December;61(6):673-6

DOI: 10.23736/S0390-5616.16.03427-X

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Decompressive craniectomy and hydrocephalus: proposal of a therapeutic flow chart

Simone PERAIO 1, Maria Lucia CALCAGNI 2, Maria Vittoria MATTOLI 2, Giammaria MARZIALI 1, Pasquale DE BONIS 3, Angelo POMPUCCI 1, Carmelo ANILE 1, Annunziato MANGIOLA 1

1 Department of Neurosurgery, School of Medicine, Catholic University, Rome, Italy; 2 Department of Nuclear Medicine, School of Medicine, Catholic University, Rome, Italy; 3 Department of Neurosurgery, S. Anna Hospital, Ferrara, Italy


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Decompressive craniectomy (DC) may be necessary to save the lives of patients suffering from intracranial hypertension. However, this procedure is not complication-free. Its two main complications are hydrocephalus and the sinking skin-flap syndrome (SSFS). The radiological findings and the clinical evaluation may be not enough to decide when and/or how to treat hydrocephalus in a decompressed patient. SSFS and hydrocephalus may be not unrelated. In fact, a patient affected by hydrocephalus, after the ventriculo-peritoneal shunt, can develop SSFS; on the other hand, SSFS per se can cause hydrocephalus. Treating hydrocephalus in decompressed patients can be challenging. Radiological findings and clinical evaluation may not be enough to define the most appropriate therapeutic strategy. Cerebrospinal fluid (CSF) dynamics and metabolic evaluations can represent important diagnostic tools for assessing the need of a CSF shunt in patients with a poor baseline neurologic status. Based on our experience, we propose a flow chart for treating decompressed patients affected by ventriculomegaly.


KEY WORDS: Decompressive craniectomy - Hydrocephalus - Positron-emission tomography

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Publication History

Issue published online: September 29, 2017
Article first published online: January 12, 2016
Manuscript accepted: January 8, 2016
Manuscript revised: January 4, 2016
Manuscript received: July 17, 2015

Cite this article as

Peraio S, Calcagni ML, Mattoli MV, Marziali G, De Bonis P, Pompucci A, et al. Decompressive craniectomy and hydrocephalus: proposal of a therapeutic flow chart. J Neurosurg Sci 2017;61:673-6. DOI: 10.23736/S0390-5616.16.03427-X

Corresponding author e-mail

simoneperaio@virgilio.it