title: Decompressive craniectomy and hydrocephalus: proposal of a therapeutic flow chart.
abstract: 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.
authors.affiliation: Department of Neurosurgery, School of Medicine, Catholic University, Rome, Italy - simoneperaio@virgilio.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Peraio
authors.affiliation: Department of Nuclear Medicine, School of Medicine, Catholic University, Rome, Italy.
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Calcagni
authors.affiliation: Department of Nuclear Medicine, School of Medicine, Catholic University, Rome, Italy.
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Mattoli
authors.affiliation: Department of Neurosurgery, School of Medicine, Catholic University, Rome, Italy.
authors.forename: Giammaria
authors.initials: G
authors.lastname: Marziali
authors.affiliation: Department of Neurosurgery, S. Anna Hospital, Ferrara, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: DE Bonis
authors.affiliation: Department of Neurosurgery, School of Medicine, Catholic University, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Pompucci
authors.affiliation: Department of Neurosurgery, School of Medicine, Catholic University, Rome, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Anile
authors.affiliation: Department of Neurosurgery, School of Medicine, Catholic University, Rome, Italy.
authors.forename: Annunziato
authors.initials: A
authors.lastname: Mangiola
mesh_terms: D056424:Decompressive Craniectomy / Q000009:adverse effects*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery; D019586:Intracranial Hypertension