Late Post Traumatic Ventriculomegally Does It Requires CSF Diversion ?
NCT ID: NCT06703164
Last Updated: 2024-11-26
Study Results
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Basic Information
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NOT_YET_RECRUITING
34 participants
OBSERVATIONAL
2024-12-01
2026-10-01
Brief Summary
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1. prevelance of ventriculomegally in post traumatic patients after head trauma
2. To determine the incidence of surgically treated ventriculomegally within 6 months from head injury in a series of consecutive adult patients undergoing acute head CT following injury.
3. importance of csf diversion in post traumatic ventriculomegally
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Detailed Description
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Its incidence deeply varies among series (0.7-50%), and this is mainly due to very different diagnostic criteria Therefore, given the very high number of patients with traumatic brain injury (TBIs), patients presenting with late post-traumatic ventriculomegally are not infrequent.
The choice of the term ventriculomegally in the title reflects the difficulty in differentiating a ventricular enlargement (secondary to post-traumatic brain damage with atrophy) from an active hydrocephalic process.
Those patients with subarachnoid hemorrhage (SAH) had a threefold risk of developing ventriculomegally compared to patients with no SAH during the 2-year follow-up period. Also, decompressive craniectomy and the presence of subdural hygroma after craniectomy seem to increase the risk for ventriculomegally.In craniectomy, the proximity of the craniotomy to the skull midline might increase the risk as well. Other possible risk factors for post traumatic ventriculomegaly include: increased age, cerebrospinal fuid infection, and intraventricular hemorrhage . Inflammation-mediated adhesions related to intracranial hemorrhages can explain the predisposition to post traumatic ventriculomegally.
In fact, practically all patients with post-traumatic ventricular enlargement present with symptoms of post-taumatic Lesions and almost never present with the Hakim-adams trriad. Some of them present nonspecific symptoms, especially arrested clinical improvement during rehabilitation programs, impaired consciousness or a worsening neurologic status .
A classic clinical feature to suspect post traumatic ventriculomegally after TBI is poor improvement or stagnation of recovery .
Early recognition of post traumatic ventriculomegally is essential in the follow-up of patients with TBIs, as cerebrospinal fluid diversion (ventricular shunting) has been shown to improve outcome during rehabilitation
Conditions
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Study Design
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COHORT
PROSPECTIVE
Study Groups
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Group 1 will be followed up by conservative management
This group will be followed up by close observation of GCS ,ct brain ,fundus examination \&may need Csf flowmetry
No interventions assigned to this group
Group 2 will undergo csf diversion
Csf diversion is either vp shunt or evd
No interventions assigned to this group
Eligibility Criteria
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Inclusion Criteria
Exclusion Criteria
3.any patient has hx of previous csf diversion .
ALL
No
Sponsors
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Assiut University
OTHER
Responsible Party
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Nargis Samir Azmi Marqus
Resident Doctor
Principal Investigators
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Mohammed Elsayed mahmoud, Clinical Professor
Role: STUDY_DIRECTOR
Assiut University
Central Contacts
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References
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De Bonis P, Mangiola A, Pompucci A, Formisano R, Mattogno P, Anile C. CSF dynamics analysis in patients with post-traumatic ventriculomegaly. Clin Neurol Neurosurg. 2013 Jan;115(1):49-53. doi: 10.1016/j.clineuro.2012.04.012. Epub 2012 May 15.
Shah AH, Komotar RJ. Pathophysiology of acute hydrocephalus after subarachnoid hemorrhage. World Neurosurg. 2013 Sep-Oct;80(3-4):304-6. doi: 10.1016/j.wneu.2013.01.110. Epub 2013 Feb 1. No abstract available.
Choi I, Park HK, Chang JC, Cho SJ, Choi SK, Byun BJ. Clinical factors for the development of posttraumatic hydrocephalus after decompressive craniectomy. J Korean Neurosurg Soc. 2008 May;43(5):227-31. doi: 10.3340/jkns.2008.43.5.227. Epub 2008 May 20.
Williams JR, Meyer MR, Ricard JA, Sen R, Young CC, Feroze AH, Greil ME, Barros G, Durfy S, Hanak B, Morton RP, Temkin NR, Barber JK, Mac Donald CL, Chesnut RM. Re-examining decompressive craniectomy medial margin distance from midline as a metric for calculating the risk of post-traumatic hydrocephalus. J Clin Neurosci. 2021 May;87:125-131. doi: 10.1016/j.jocn.2021.02.025. Epub 2021 Mar 20.
De Bonis P, Pompucci A, Mangiola A, Rigante L, Anile C. Post-traumatic hydrocephalus after decompressive craniectomy: an underestimated risk factor. J Neurotrauma. 2010 Nov;27(11):1965-70. doi: 10.1089/neu.2010.1425.
Lu VM, Carlstrom LP, Perry A, Graffeo CS, Domingo RA, Young CC, Meyer FB. Prognostic significance of subdural hygroma for post-traumatic hydrocephalus after decompressive craniectomy in the traumatic brain injury setting: a systematic review and meta-analysis. Neurosurg Rev. 2021 Feb;44(1):129-138. doi: 10.1007/s10143-019-01223-z. Epub 2019 Dec 16.
Fattahian R, Bagheri SR, Sadeghi M. Development of Posttraumatic Hydrocephalus Requiring Ventriculoperitoneal Shunt After Decompressive Craniectomy for Traumatic Brain Injury: a Systematic Review and Meta-analysis of Retrospective Studies. Med Arch. 2018 Jun;72(3):214-219. doi: 10.5455/medarh.2018.72.214-219.
Mazzini L, Campini R, Angelino E, Rognone F, Pastore I, Oliveri G. Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome. Arch Phys Med Rehabil. 2003 Nov;84(11):1637-41. doi: 10.1053/s0003-9993(03)00314-9.
Hawkins TD, Lloyd AD, Fletcher GI, Hanka R. Ventricular size following head injury: a clinico-radiological study. Clin Radiol. 1976 Jul;27(3):279-89. doi: 10.1016/s0009-9260(76)80069-4.
Majdan M, Plancikova D, Brazinova A, Rusnak M, Nieboer D, Feigin V, Maas A. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016 Dec;1(2):e76-e83. doi: 10.1016/S2468-2667(16)30017-2. Epub 2016 Nov 29.
Other Identifiers
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Post traumatic Hcp
Identifier Type: -
Identifier Source: org_study_id
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