Long-term outcomes after shunt implantation in patients with posttraumatic hydrocephalus and severe conscious disturbance

摘要

BACKGROUND: Posttraumatic hydrocephalus (PTH) is a frequent complication secondary to traumatic brain injury, especially among patients keeping chronic unconscious. And effects of shunt implantation on improving outcomes among these patients are still controversial. This study was aimed to assess the long-term outcomes following shunt implantation among patients who had PTH and kept chronic unconscious. METHODS: A prospective study was performed to include patients who had PTH and remained in severe conscious disturbance from March 2010 to December 2010. All of included patients would have shunt implantation and be closely followed up at least for 2 years to assess final outcomes. RESULTS: Fifteen patients having PTH were identified. Before shunt implantation, 2 patients kept vegetative state (Glasgow Outcome Scale [GOS] score 2), and 13 patients kept minimally consciousness with severe disability (GOS score 3). After shunt implantation, the shunt device was removed because of intracranial infection in 1 patient, and the other patient died because of allergic shock. Among the remaining 13 patients, finally 7 patients had improvement on GOS or Modified Barthel Index (MBI) score during the 2-year follow-up, but only 1 patient achieved a good outcome (GOS score 4, independent life). Among them, 5 patients' outcomes improved as assessed by GOS or MBI score during the first 3 months following shunt implantation. During the fourth to sixth month following shunt implantation, there were 2 patients who showed first rise on GOS or MBI score. Beyond 6 months, no patient showed initial improvement. And among patients who showed improvement, most of them kept improving during a certain time. CONCLUSIONS: A proportion of patients who had PTH and remained in severe conscious disturbance would benefit from shunt implantation, and the improvement may turn up late after this procedure.