BACKGROUND AND PURPOSE Posttraumatic hydrocephalus affects 11.9%-36% of patients undergoing decompressive craniectomy (DC) after traumatic brain injury and necessitates a ventriculo-peritoneal shunt placement. As bone and arachnoid trabeculae share the same collagen type, we investigated possible connections between the skull Hounsfield unit (HU) values and shunt-dependent hydrocephalus (SDHC) in patients that received cranioplasty after DC for traumatic acute subdural hematoma (SDH). METHODS We measured HU values in the frontal bone and internal occipital protuberance from admission brain CT. Receiver operating characteristic curve analysis was performed to identify the optimal cut-off skull HU values for predicting SDHC in patients receiving cranioplasty after DC due to traumatic acute SDH. We investigated independent predictive factors for SDHC occurrence using multivariable logistic regression analysis. RESULTS A total of 162 patients (>15 years of age) were enrolled in the study over an 11-year period from two university hospitals. Multivariable logistic analysis revealed that the group with simultaneous frontal skull HU ≤797.4 and internal occipital protuberance HU ≤586.5 (odds ratio, 8.57; 95% CI, 3.05 to 24.10; P<0.001) was the only independent predictive factor for SDHC in patients who received cranioplasty after DC for traumatic acute SDH. CONCLUSIONS Our study reveals a potential relationship between possible low bone mineral density and development of SDHC in traumatic acute SDH patients who had undergone DC. Our findings provide deeper insight into the association between low bone mineral density and hydrocephalus after DC for traumatic acute SDH.

中文翻译：

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颅骨Hounsfield单元是否可以预测颅骨硬膜下血肿减压开颅手术后分流依赖性脑积水？

背景与目的颅脑外伤后进行减压颅骨切除术（DC）的创伤后脑积水会影响11.9％-36％的患者，并需要进行脑室-腹膜分流。由于骨和蛛网膜小梁具有相同的胶原蛋白类型，因此我们研究了因创伤性急性硬脑膜下血肿（SDH）接受DC颅骨成形术的患者颅骨Hounsfield单位（HU）值与分流依赖性脑积水（SDHC）之间的可能联系。方法我们通过入院脑CT测量了额骨和枕骨内突起的HU值。进行受试者工作特征曲线分析以鉴定最佳的颅骨切除HU值，以预测DC因创伤性急性SDH接受颅骨成形术的患者的SDHC。我们使用多元逻辑回归分析调查了SDHC发生的独立预测因素。结果在11年的时间里，共有162名患者（> 15岁）从两家大学医院入选。多变量逻辑分析显示，同时额颅骨HU≤797.4，枕骨内突HU≤586.5（优势比，8.57； 95％CI，3.05至24.10； P <0.001）的组是SDHC患者中唯一独立的预测因素DC致创伤性急性SDH后接受颅骨成形术。结论我们的研究揭示了在遭受DC的创伤性急性SDH患者中可能的低骨矿物质密度与SDHC的发展之间的潜在关系。