Correlation Between Medial Margin-to-Midline Distance in Decompressive Craniectomy and Postoperative Hydrocephalus
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Abstract
Purpose: To evaluate whether decompressive craniectomy with a distance to the midline (DTM) of 2.5 cm. is associated with post-craniectomy hydrocephalus in patients with traumatic brain injury and stroke, and to determine the optimal DTM cut-off value with the highest specificity for predicting post-craniectomy hydrocephalus.
Method: A retrospective analysis study was conducted on patients who were diagnosed with traumatic brain injury, ischemic infarction and hemorrhagic stroke who underwent decompressive craniectomy. A 3D reconstruction CT scan was used to determine the DTM and follow up post-operative hydrocephalus.
Results: In 109 patients, the mean DTM was significantly shorter in the post-craniectomy hydrocephalus group (2.07+0.89 cm) compared to the non-hydrocephalus group (2.48+1.12 mm; P=0.033). Univariate analysis showed that DTM <2.5 cm was associated with hydrocephalus (crude OR=2.39; 95% CI: 1.10–5.28; P=0.029). However, after adjusting for potential confounders (age, post-operative GCS, ICH, infection, evacuation, and IVH) using multiple logistic regression, DTM was not an independent predictor of hydrocephalus (adjusted OR=2.17; 95% CI: 0.85–5.68; P=0.107). Significant independent risk factors identified were age (P=0.013) and intraventricular hemorrhage (P=0.044). We found the maximum specificity cut-point found that interval more or less than 1.64 centimeters, so that more incidence of hydrocephalus. However, adjusted for this by multiple logistic regression, found no significant difference between the interval of midline and margin of craniectomy and the occurrence of hydrocephalus.
Conclusion: While a medial margin-to-midline distance (DTM) of <2.5 cm showed an initial association with hydrocephalus in univariate analysis, it was not identified as an independent risk factor in the multivariable model. Advanced age and intraventricular hemorrhage (IVH) are the primary independent predictors of post-craniectomy hydrocephalus. Clinical risk assessment should prioritize these patient-related factors alongside surgical considerations.
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