Introduction: Hydrocephalus is a recognised complication of surgical interventions in the posterior fossa. It is rarely considered in the risk profile of microvascular decompressions, but there has been increasing recognition recently that it may be more common than first thought. We undertook this study to examine the incidence of post operative hydrocephalus in our patients undergoing microvascular decompression for trigeminal neuralgia or facial spasm.
Methods: A retrospective study of all patients undergoing microvascular decompression of the fifth or seventh cranial nerves at our institution between 2005 and 2015.
Results: 180 patients underwent microvascular decompression during the time period in question. 9 patients subsequently developed hydrocephalic symptoms requiring permanent CSF diversion. Two presented with acute hydrocephalus within five days of operation, whilst the others displayed a more insidious onset between 2 weeks and a year. 5 patients underwent standard ventriculo-peritoneal shunt insertion, and 4 lumbo-peritoneal shunting. There was no link observed between post operative haematoma, infection, or revision surgery and in the incidence of hydrocephalus in our patient population.
Conclusions: Our patient population currently runs a risk of 5% of developing symptomatic hydrocephalus requiring surgical intervention. We have not demonstrated a link between this and other post operative complications, though the numbers are far too small to draw any conclusive links. Hydrocephalus remains a significant, and perhaps underappreciated complication of microvascular decompression, and should certainly be discussed with patients during the consent process.
Patient Care: Hydrocephalus is an underappreciated complication of microvascular decompression. This work serves to better inform surgeons and patients regarding the associated risks of surgery.
Learning Objectives: By the conclusion of this session, participants should appreciate the incidence of hydrocephalus following microvascular decompression, allowing them to better consent their patients.