Posttraumatic Hydrocephalus Treatment & Management

Updated: Feb 03, 2021
  • Author: John J Danko, DO, FAAPMR; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Treatment

Rehabilitation Program

Physical Therapy

The resumption of rehabilitation is usually prompt after the placement of a ventriculoperitoneal (VP) shunt. [29, 30] Patients are typically observed for 2-3 days postoperatively. They then return to rehabilitation services to complete their brain-injury rehabilitation program. Successful shunting is usually related to more obvious and rapid improvements during rehabilitation efforts. [31]

A study by Weintraub et al indicated that earlier shunting in posttraumatic hydrocephalus (PTH) is associated with improved rehabilitation outcomes. The study involved 52 PTH patients who had a VP shunt placed, with the period from injury to placement ranging from 9 to 366 days (median time, 69 days). [32]

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Surgical Intervention

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  • Before treatment, conditions such as infection, anemia, hypoxia, seizure disorder, uremia, and encephalopathy must be ruled out or addressed. If PTH is suspected, prompt neurosurgical evaluation is highly recommended.

  • Shunting is the most common treatment for hydrocephalus. The outcome is usually favorable.

  • A shunt is usually placed from the right ventricle to the peritoneal space. The right side is normally used to avoid injury to the language centers on the left side of the brain. Shunts are usually equipped with reservoirs that are used for transiently increasing output and for testing the patency of flow.

  • Patients with acute presentations and clear signs of high-pressure hydrocephalus benefit from a shunting procedure. Patients with chronic presentations can be observed with frequent CT scanning of the brain to monitor for progression of hydrocephalus. [6]

  • In a study by Tribl and Oder, 52% of patients with PTH had significant improvement within 3 months of shunting. [33]

  • Patients with NPH also may benefit from a shunting procedure. In patients with a TBI and communicating hydrocephalus, Groswasser found that shunting promoted a recovery of consciousness and motor capacity but not a return of neurobehavioral function. [7]

  • Complications and shunt malfunctions are common. [33, 29] Complications of shunts include the following:

    • Infection - Wound infection or contamination during placement

    • Shunt failure - Displacement and leakage

    • Occlusion - Kinking and tube clotting

    • Overshunting - More fluid is shunted than necessary

    • Placement errors

  • Assessing the efficacy of surgical intervention can be problematic because of the heterogeneity of TBI severity, TBI location, nonuniform diagnostic criteria used across studies, variants of PTH, the severity of PTH, and the length of time between the occurrence of a TBI and the development of PTH. Further research is needed to control for confounding factors, elucidate criteria for surgical intervention, and assess the outcome of surgery. [17]

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Consultations

When hydrocephalus is confirmed, consultation with a neurosurgeon should be expedited. Additionally, consultation with a physical medicine and rehabilitation specialist to evaluate for functional impairments and design a patient-centered rehabilitation program is recommended.

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