Objective To explore the risk factors for postoperative secondary hydrocephalus in patients with severe craniocerebral injury and construct a nomogram prediction model.

Methods A total of 360 patients with severe craniocerebral injury were selected as the study subjects, and divided into hydrocephalus group (n=34) and non-hydrocephalus group (n=326) based on the occurrence of postoperative secondary hydrocephalus. Logistic regression analysis was used to screen for risk factors of postoperative secondary hydrocephalus. A nomogram model for predicting postoperative secondary hydrocephalus in patients with severe craniocerebral injury was constructed based on the identified risk factors, and its predictive performance was validated.

Results Among the 360 patients, 34 developed secondary hydrocephalus after surgery, with an incidence rate of 9.44% (34/360). Logistic regression analysis revealed that intracranial infection, ventricular hemorrhage, midline shift ≥12 mm, preoperative Glasgow Coma Scale (GCS) score of 3 to 5, decompressive craniectomy and dura mater opening were independent risk factors for postoperative secondary hydrocephalus in patients with severe traumatic brain injury (P < 0.05). The concordance index of the nomogram model constructed based on these risk factors was 0.874, and the area under the curve was 0.831.

Conclusion The nomogram model constructed in this study based on factors such as intracranial infection, ventricular hemorrhage, midline shift, preoperative GCS score, decompressive craniectomy and dura mater opening, effectively predicts risk of postoperative secondary hydrocephalus in patients with severe traumatic brain injury. This model has clinical significance for early prevention and treatment.