BACKGROUND:

Hydrocephalus is a common complication following decompressive craniectomy (DC). Ventriculoperitoneal shunt (VPS) was required for some patients before receiving cranioplasty (CP). Presence of a VPS is regarded as a risk factor for overall CP complications.

METHODS:

A retrospective survey was conducted on the 176 cases of traumatic brain injury (TBI) patients who underwent late (> 3 months) titanium CP (Ti-CP) in our hospital from April 2014 to July 2018. Thirteen patients (7.4%) had preoperative VPS. Propensity score matching was performed for these 13 patients with a ratio of 1:5. A total of 78 patients were selected. Preoperative clinical parameters and postoperative complications were analyzed. The period of postoperative follow-up ranged from 3-63 months (mean 21.3±17.0 months).

RESULTS:

The overall complication rate was higher in the VPS group (P=0.010). These patients were more likely to develop sunken skin flap (P<0.001). The rate of postoperative cerebral hemorrhage was higher in the VPS group. Logistic analysis showed that preoperative VPS was the independent risk factor for postoperative EDC (odds ratio=17.714, P<0.001). VPS was not related to postoperative infection and seizure. The postoperative drainage duration longer than 2.5 days significantly increased the risk of postoperative infection (odds ratio=7.715, P=0.023).

CONCLUSIONS:

Presence of a VPS significantly increased the risk of EDC in TBI patients underwent late Ti-CP. It also related to postoperative hemorrhage. The sunken skin flap in VPS patients increased surgical difficulty and the likelihood of extradural accumulation. Preoperative VPS was not related to postoperative infection and seizure in Ti-CP.

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