Malignant cerebral swelling following cranioplasty

Honeybul, Stephen; Damodaran, Omprakash; Lind, Christopher R. P.; Lee, G.

doi:10.1016/j.jocn.2016.01.014

Cited by 16 publications

(6 citation statements)

References 17 publications

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“…[26] In his treatise, Dieulafoy cautioned that “the operator must be condemned who makes use of aspiration without understanding.”[2627] The induction of acute intracranial hypotension by subgaleal drains can result in catastrophic outcomes. [1112131415161718192021222324252832] Our patient likely experienced ATH when vacuum suction to the supratentorial compartment was applied. The immediate clamping of the subgaleal drain with subsequent recovery of the patient's consciousness and stabilization of vital signs supports this theory.…”

Section: Discussionmentioning

confidence: 97%

“…Sviri [22] can result in catastrophic outcomes. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]28,32] Our patient likely experienced ATH when vacuum suction to the supratentorial compartment was applied. The immediate clamping of the subgaleal drain with subsequent recovery of the patient's consciousness and stabilization of vital signs supports this theory.…”

Section: Outcomementioning

confidence: 99%

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The “negative” impact of a subgaleal drain: Post-cranioplasty negative pressure subgaleal drain-induced ascending transtentorial herniation

Woo

Wong

et al. 2019

Asian J Neurosurg

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One commonly practiced procedural step to reduce the risk of postoperative hematoma accumulation when performing cranioplasties is to place a closed negative-pressure subgaleal drain. We present a patient with sinking skin flap syndrome that underwent such a procedure and subsequently experienced immediate postoperative ascending transtentorial herniation and intracranial hemorrhage remote from the surgical site. On determining that the subgaleal drain was the responsible cause, it was immediate removed, and the patient had neurological recovery. Fewer than 30 cases of life-threatening subgaleal drain-related complications have been documented, and this is the first reported case of ascending herniation occurring after cranioplasty. This report illustrates the potential risks of subgaleal drainage, the importance of early recognition of this rare phenomenon and that intervention can be potentially life-saving.

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Section: Discussionmentioning

confidence: 97%

Section: Outcomementioning

confidence: 99%

The “negative” impact of a subgaleal drain: Post-cranioplasty negative pressure subgaleal drain-induced ascending transtentorial herniation

Woo

Wong

et al. 2019

Asian J Neurosurg

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“…The large cavity between the heavily collapsed brain and plate is filled by the collapsed brain, resulting in rapid hemodynamic pressure changes. 2,5,7,8 More than half of the cases reported in Shen et al had SSFS and additionally had a closed vacuum suction system placed under the flap; therefore, SSFS and vacuum suction drainage may portend an increased risk of postoperative massive brain swelling. 5 After cranioplasty, the ICP is drastically changed and cerebral perfusion pressure is inadequately low, resulting in cerebral hypoxia, infarct, and secondary swelling.…”

Section: Discussionmentioning

confidence: 99%

“…As described in Sviri et al and Honeybul et al, sinking skin flap syndrome (SSFS) may occur if the brain gravity and atmospheric pressure exceeds the ICP and produces a cavity when the craniectomy is performed. The large cavity between the heavily collapsed brain and plate is filled by the collapsed brain, resulting in rapid hemodynamic pressure changes 2,5,7,8 . More than half of the cases reported in Shen et al had SSFS and additionally had a closed vacuum suction system placed under the flap; therefore, SSFS and vacuum suction drainage may portend an increased risk of postoperative massive brain swelling 5 .…”

Section: Discussionmentioning

confidence: 99%

Reversible Malignant Cerebral Edema Following Cranioplasty

Klavansky

Roa

Liang

et al. 2023

Neurology & Clinical Neurosc

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A 44‐year‐old female underwent cranioplasty 6 months after a malignant right MCA stroke. Three hours later, she became unresponsive, with new left‐gaze deviation and right‐side hemiparesis. CT head showed new right MCA hypodensity and diffuse edema. After aggressive medical management, she returned to baseline. A brain MRI showed no stroke. Malignant cerebral edema after uneventful cranioplasty is a rare and often fatal complication related to sudden intracranial negative pressure and altered cerebral autoregulation. This is a rare case in which a patient developed malignant cerebral edema and status epilepticus after cranioplasty and survived.

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“…[2][3][4] Massive brain swelling occurring after cranioplasty is a rare complication associated with high mortality, but is increasingly reported; the underlying cause remains unclear. [5][6][7][8][9][10][11] In this study, we report a case of fatal brain swelling after cranioplasty and discuss the possible mechanisms underlying this complication.…”

Section: Introductionmentioning

confidence: 99%

Massive Brain Swelling after Cranioplasty: A Case Report

Zhang

Pan

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background Cranioplasty is a common procedure in neurosurgery. It is usually performed following decompressive craniectomy (DC). However, complications may occur after the operation, such as massive brain swelling. Up to now, far too little attention has been given to this severe complication. We report one case of fatal cerebral swelling after cranioplasty and analyze the possible mechanism of this complication. Case Description The patient was a 40-year-old man who had a severe right basal ganglia cerebral hemorrhage and underwent DC ∼ 2 months before. One day before scheduled cranioplasty, a lumbar cerebrospinal fluid drainage was placed. The cranioplasty itself was uneventful. However, he gradually fell into a coma, and his right pupil was moderately dilated 20 hours after the surgery. A brain computed tomography (CT) scan indicated massive right cerebral edema with compressed right midbrain. The patient did not regain consciousness, and he remained quadriplegic. Conclusion It is necessary to increase awareness of complications of cranioplasty in high-risk patients. The lessons learned from this case include avoiding excessive drainage of cerebrospinal fluid. Patients with low-density lesions in the brain need to be treated with caution. Once the CT scan shows massive cerebral swelling, the patient has a poor prognosis.

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Malignant cerebral swelling following cranioplasty

Cited by 16 publications

References 17 publications

The “negative” impact of a subgaleal drain: Post-cranioplasty negative pressure subgaleal drain-induced ascending transtentorial herniation

The “negative” impact of a subgaleal drain: Post-cranioplasty negative pressure subgaleal drain-induced ascending transtentorial herniation

Reversible Malignant Cerebral Edema Following Cranioplasty

Massive Brain Swelling after Cranioplasty: A Case Report

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