Objective:

To evaluate the association between interhemispheric hygroma and hydrocephalus after decompressive craniectomy (DC) and to explore whether hygroma thickness may help identify patients at higher risk of treatment requirement.

Approach:

Key Findings:

• Atotalof104patientswereincluded;52(50%)developedradiologicalhydrocephalus.Themedianfollow-upofthecohortwas13.9months(IQR3.8–31.1).Follow-updurationdifferedsignificantlybetweenpatientswithandwithoutradiologicalhydrocephalus(21vs.12.3months;p=0.013),andbetweentreatedandnon-treatedhydrocephalus(32vs.12.4months;p<0.001).Interhemispherichygromathicknesswasgreaterinpatientswithhydrocephalus(OR1.19permm;95%CI1.03–1.39).Inthesubgroupwithtreatedhydrocephalus,hygromathicknesswasindependentlyassociatedwithtreatmentrequirement(OR1.30permm;95%CI1.01–1.67).ROCanalysisshowedgooddiscriminativeperformance(AUC0.81).Athresholdofapproximately8mmdemonstratedhighsensitivityforpredictingtreatment.

Interpretation:

Interhemispheric hygroma thickness is associated with post-traumatic hydrocephalus after DC and with treatment requirement.

Limitations:

• Theretrospectivedesignmayintroducebias.Thesingle-centerstudylimitsgeneralizability.Externalvalidationoffindingsisneeded.

Conclusion:

Hygroma thickness may serve as a radiological parameter for postoperative monitoring, pending further validation.

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