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Despite its significant impact on recovery and long-term outcomes, the relative contribution of pre-operative, intra-operative, and post-operative factors to PTH development remains incompletely understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify and quantify independent risk factors for PTH following decompressive craniectomy and develop a clinically applicable risk stratification framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort analysis of 142 consecutive patients who underwent decompressive craniectomy for TBI was conducted. The primary outcome was radiologically defined hydrocephalus. Pre-operative, intra-operative, and post-operative clinical and radiological variables were analysed using univariable and multivariable logistic regression. Model performance was assessed using area under the receiver operating characteristic curve (AUC), Hosmer\u2013Lemeshow goodness-of-fit testing, and pseudo-R\n                      <jats:sup>2<\/jats:sup>\n                      values.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Hydrocephalus developed in 43 patients (30.3%). Univariable analysis identified lower Glasgow Coma Scale (GCS) on arrival, post-operative interhemispheric hygroma, subdural hygroma, herniation, intraventricular haemorrhage, and pseudomeningocele as significant predictors (all P\u2009&lt;\u20090.01). Intraoperative surgical parameters showed no association with PTH. The final multivariable model identified two independent predictors: lower GCS on arrival (OR 0.88, 95% CI 0.79\u20130.99; P\u2009=\u20090.032) and post-operative interhemispheric hygroma (OR 4.89, 95% CI 1.95\u201312.28; P\u2009=\u20090.0007). The model demonstrated strong discrimination (AUC\u2009=\u20090.807) and excellent calibration (Hosmer\u2013Lemeshow P\u2009=\u20090.69), with overall classification accuracy of 81.0%. GCS score of\u2009\u2264\u20098 on arrival was significantly associated with increased hydrocephalus risk in binary analysis (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007), whereas the same threshold at intubation was not significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Post-operative complications, particularly interhemispheric hygroma, are the strongest predictors of PTH following decompressive craniectomy, while surgical technique parameters show no significant association. These findings support the implementation of structured post-operative surveillance protocols to enable early detection and intervention in high-risk patients. A clinical risk assessment checklist incorporating these factors may improve prognostic accuracy and guide individualised management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-026-06865-9","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T20:54:34Z","timestamp":1776891274000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The paradox of relief: how decompression sets the stage for hydrocephalus\u2014a retrospective inquiry into its clinical determinants"],"prefix":"10.1007","volume":"168","author":[{"given":"Muhammad","family":"Daniyal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Samir Irfan","family":"Wasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Podlasek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"issue":"1","key":"6865_CR1","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-025-03232-7","volume":"48","author":"S Bagherzadeh","year":"2025","unstructured":"Bagherzadeh S, Bahari L, Roohollahi F (2025) Post-craniectomy hydrocephalus in adult traumatic brain injury patients: a systematic review and meta-analysis of risk factors and outcome. 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