{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:49:46Z","timestamp":1782103786951,"version":"3.54.5"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Post-traumatic hydrocephalus (PTH) is a recognized complication following decompressive craniectomy (DC) in patients with traumatic brain injury (TBI). Reported risk factors remain inconsistent across studies. Interhemispheric subdural hygroma has been suggested as a potential radiological marker, although its quantitative relevance has not been clearly established. This study aimed to evaluate the association between interhemispheric hygroma and hydrocephalus after DC and to explore whether hygroma thickness may help identify patients at higher risk of treatment requirement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study at a Level I trauma center including patients older than 15\u202fyears who underwent DC for TBI between 2011 and 2025. Radiological hydrocephalus was defined using a modified frontal horn index &amp;gt;33% combined with Gudeman CT criteria. Clinical, surgical, and radiological variables were analyzed. Multivariable logistic regression was used to identify independent associations. The discriminative performance of interhemispheric hygroma thickness for predicting hydrocephalus requiring treatment was assessed using receiver operating characteristic (ROC) curve analysis, and the optimal threshold was determined using the Youden index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 104 patients were included; 52 (50%) developed radiological hydrocephalus. The median follow-up of the cohort was 13.9\u202fmonths (IQR 3.8\u201331.1). Follow-up duration differed significantly between patients with and without radiological hydrocephalus (21 vs. 12.3\u202fmonths;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.013), and between treated and non-treated hydrocephalus (32 vs. 12.4\u202fmonths;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Interhemispheric hygroma thickness was greater in patients with hydrocephalus and remained independently associated in multivariable analysis (OR 1.19 per mm; 95% CI 1.03\u20131.39). In the subgroup with treated hydrocephalus, hygroma thickness also remained independently associated with treatment requirement (OR 1.30 per mm; 95% CI 1.01\u20131.67). ROC analysis showed good discriminative performance (AUC 0.81).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A threshold of approximately 8\u202fmm demonstrated high sensitivity with acceptable specificity for predicting treatment. Interhemispheric hygroma thickness was independently associated with post-traumatic hydrocephalus after DC and with subsequent treatment requirement. These findings suggest that hygroma thickness may represent a useful radiological parameter for postoperative monitoring, although external validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1815427","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:37:10Z","timestamp":1782103030000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors determining hydrocephalus after decompressive craniectomy: the role of interhemispheric hygroma"],"prefix":"10.3389","volume":"17","author":[{"given":"Andreea-Emanuela","family":"Baciu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre","place":["Madrid, Spain"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana-M. Casta\u00f1o","family":"Le\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre","place":["Madrid, Spain"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12)","place":["Madrid, Spain"]},{"name":"Departamento de Cirug\u00eda, Facultad de Medicina, Universidad Complutense de Madrid","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sof\u00eda Mart\u00ednez","family":"Molina","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre","place":["Madrid, Spain"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Lagares","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre","place":["Madrid, Spain"]},{"name":"Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12)","place":["Madrid, Spain"]},{"name":"Departamento de Cirug\u00eda, Facultad de Medicina, Universidad Complutense de Madrid","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1007\/s00134-019-05805-9","article-title":"A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)","volume":"45","author":"Hawryluk","year":"2019","journal-title":"Intensive Care Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.3171\/jns.1996.85.6.1026","article-title":"Posttraumatic ventriculomegaly: hydrocephalus or atrophy? A new approach for diagnosis using CSF dynamics","volume":"85","author":"Marmarou","year":"1996","journal-title":"J Neurosurg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s10143-025-03232-7","article-title":"Post-craniectomy hydrocephalus in adult traumatic brain injury patients: a systematic review and meta-analysis of risk factors and outcome","volume":"48","author":"Bagherzadeh","year":"2025","journal-title":"Neurosurg Rev"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1089\/neu.2010.1612","article-title":"Long-term complications of decompressive craniectomy for head injury","volume":"28","author":"Honeybul","year":"2011","journal-title":"J Neurotrauma"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"355","DOI":"10.3340\/jkns.2011.49.6.355","article-title":"Risk factors associated with subdural hygroma after decompressive craniectomy in patients with traumatic brain injury: a comparative study","volume":"49","author":"Jeon","year":"2011","journal-title":"J Korean Neurosurg Soc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e188","DOI":"10.1016\/j.wneu.2021.02.052","article-title":"Extra-axial fluid collections after decompressive craniectomy: management, outcomes and treatment algorithm","volume":"149","author":"DiRisio","year":"2021","journal-title":"World Neurosurg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1007\/s00701-008-0145-9","article-title":"Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases","volume":"150","author":"Yang","year":"2008","journal-title":"Acta Neurochir"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.3171\/2010.4.JNS10132","article-title":"Interhemispheric hygroma after decompressive craniectomy: does it predict posttraumatic hydrocephalus?","volume":"113","author":"Kaen","year":"2010","journal-title":"J Neurosurg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1016\/j.clineuro.2012.12.011","article-title":"Decompressive craniectomy, interhemispheric hygroma and hydrocephalus: a timeline of events?","volume":"115","author":"De Bonis","year":"2013","journal-title":"Clin Neurol Neurosurg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1080\/01616412.2000.11741034","article-title":"Post-traumatic hydrocephalus","volume":"22","author":"Guyot","year":"2000","journal-title":"Neurol Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1111\/jon.13058","article-title":"Effects of cranioplasty in cerebral blood perfusion using quantification with 99m-Tc HMPAO SPECT-CT","volume":"33","author":"Galiana","year":"2023","journal-title":"J Neuroimaging"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1586","DOI":"10.1089\/neu.2015.4261","article-title":"The effect of cranioplasty on cerebral Hemodynamics as measured by perfusion computed tomography and Doppler ultrasonography","volume":"33","author":"Paredes","year":"2016","journal-title":"J Neurotrauma"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"227","DOI":"10.18071\/isz.69.0227","article-title":"Syndrome of the trephined-underestimated and poorly understood complication after decompressive craniectomy","volume":"69","author":"L\u00e1ng","year":"2016","journal-title":"Ideggyogy Sz"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"102761","DOI":"10.1016\/j.bas.2024.102761","article-title":"Consensus-based recommentations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel","volume":"4","author":"Iaccarino","year":"2024","journal-title":"Brain Spine"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1815427\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:37:20Z","timestamp":1782103040000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1815427\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":14,"alternative-id":["10.3389\/fneur.2026.1815427"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1815427","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]},"article-number":"1815427"}}