title: Role of Post-Decompressive Hydrocephalus in Patients with Malignant Cerebral Infarction.
abstract: OBJECTIVE
  The association between post-decompressive hydrocephalus and clinical neurological expression is still unclear. In order to investigate this relationship, the authors analyze series of ventricular morphology and level of consciousness at different clinical stages for patients accepting decompressive craniectomy (DC).
  
  
  METHODS
  From 2005 to 2011, 13 patients accepting DC under the diagnosis of malignant cerebral infarction were retrospectively evaluated in terms of ventricular frontal horn dilatation and level of consciousness, Glasgow Coma Scale score, at four different clinical stages: 1): pre-DC stage; 2): post-DC stage while stabilization; 3): post-cranioplasty stage; 4): post-shunt stage [for those with permanent cerebrospinal fluid (CSF) diversion].
  
  
  RESULTS
  All 13 patients had ventricular dilatation and two of them had extra-axial CSF collection. Restoration of ventricular dilatation was not observed in all patients after bone flap placement, but extra-axial CSF collection resorbed spontaneously. Four patients accepting permanent CSF diversion had no improvement over neurological expression. Otherwise, two of them complicated with subdural effusion after shunt placement.
  
  
  CONCLUSIONS
  Decompressive craniectomy itself would lead to ventricular dilatation universally. There is no direct association between degree of ventriculomegaly and neurological expression. Permanent CSF diversion surgery as treatment for ventriculomegaly makes no clinical improvement with possible complications of overshunting.
authors.affiliation: Tri-Service General Hospital, National Defense Medical Center, Department of Neurological Surgery, Taipei, Taiwan, R.O.C.
authors.forename: Bon-Jour
authors.initials: BJ
authors.lastname: Lin
authors.forename: Kuan-Nein
authors.initials: KN
authors.lastname: Chou
authors.forename: Shai-Wei
authors.initials: SW
authors.lastname: Feng
authors.forename: Da-Tong
authors.initials: DT
authors.lastname: Ju
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Ma
authors.forename: Dueng-Yuan
authors.initials: DY
authors.lastname: Hueng
mesh_terms: D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000150:complications*; D002557:Cerebrospinal Fluid Shunts; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult