To assess the clinical efficacy and safety of cranioplasty combined with ipsilateral ventricular shunt in the treatment of skull defect with hydrocephalus.

The clinical data of 78 patients with skull defect and hydrocephalus were analyzed retrospectively. All patients were treated by cranioplasty and ventriculoperitonea shunt in one stage, including 35 cases of cranioplasty combined with ipsilateral ventriculoperitonea shunt and 43 cases of contralateral operation.

The incision length [(28.97±4.55) cm], operation time [(139.00±42.27) min], and intraoperative hemorrhage [(174.57±79.35) ml] in the ipsilateral operation group were significantly better than those in the contralateral operation group [(37.15±5.83) cm, (214.07±34.35) min, and (257.21±72.02) ml, respectively] (t=6.786, 8.656 and 4.815, respectively; P＜0.001).The degree of postoperative hydrocephalus in the two groups was significantly improved (P＜0.001), but there was no significant difference between the two groups (P＞0.05). Among the postoperative complications, there was no significant difference in infection, epilepsy, subdural effusion, titanium plate effusion, or excessive cerebrospinal fluid drainage between the two groups (P＞0.05). The incidence of intracranial hemorrhage in the ipsilateral operation group (2.86%) was significantly lower than that in the contralateral operation group (20.93%; χ²=4.138, P=0.042). The postoperative Glasgow coma scale (GCS) scores of the two groups were improved compared with those before surgery (P＜0.05), but there was no significant difference in the postoperative GCS scores between the two groups (P＞0.05). At 6 months after surgery, there was no statistically significant difference in Glasgow outcome scale score between the two groups (χ²=0.005, P=0.944).

Cranioplasty combined with ipsilateral ventriculoperitoneal shunt has the same therapeutic effect as contralateral operation, but it has the advantages of shorter operation time, less trauma, less bleeding, and less risk of intracranial hemorrhage.