„Paradoxe” Herniation nach Entlastungstrepanation

Schwab, Stefan; Erbguth, Frank; Aschoff, A.; Orberk, E.; Spranger, Matthias; Hacke, Werner

doi:10.1007/s001150050360

Cited by 36 publications

(20 citation statements)

References 15 publications

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“…Patients with paradoxical herniation should be treated with intravenous fluids, Trendelenburg positioning, and clamping of CSF drainage; hyperosmolar therapy should be discontinued, and early attention given to insertion of a blood patch. 61,76,93 Cranioplasty may act to reduce the negative pressure gradient and should also be considered in the management of paradoxical herniation.…”

Section: Postoperative Complications Within 30 Daysmentioning

confidence: 99%

Complications of decompressive craniectomy for traumatic brain injury

Stiver¹

2009

FOC

382

302

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Decompressive craniectomy is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balance in decision-making during evaluation of potential surgical candidates. To further evaluate the complications of decompressive craniectomy, a review of the literature was performed following a detailed search of PubMed between 1980 and 2009. The author restricted her study to literature pertaining to decompressive craniectomy for patients with TBI. An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy. The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI. Within the 1st week following decompression, CSF circulation derangements manifest commonly as subdural hygromas. Paradoxical herniation following lumbar puncture in the setting of a large skull defect is a rare, potentially fatal complication that can be prevented and treated if recognized early. During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy. The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.

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Section: Postoperative Complications Within 30 Daysmentioning

confidence: 99%

Complications of decompressive craniectomy for traumatic brain injury

Stiver¹

2009

FOC

382

302

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“…5 Subsequently, 13 more patients with paradoxical herniation provoked by lumbar puncture were described in a series of 4 cases, whose authors first used the term "paradoxical herniation," 16 and in 9 single case reports. 2,[8][9][10][11]14,17,19,20 Cases of paradoxical herniation provoked by lumbar puncture are summarized in Table 1.…”

mentioning

confidence: 99%

Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture or ventriculoperitoneal shunting

Creutzfeldt¹,

Vilela

Longstreth

2015

JNS

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OBJECT Two patients who underwent decompressive craniectomy after head trauma deteriorated secondary to paradoxical herniation, one after lumbar puncture and the other after ventriculoperitoneal shunting. They motivated the authors to investigate further provoked paradoxical herniation. METHODS The authors reviewed the records of 205 patients who were treated at a single hospital with decompressive craniectomy for head trauma to identify those who had had lumbar puncture performed or a ventriculoperitoneal shunt placed after craniectomy but before cranioplasty. Among the patients who met these criteria, those with provoked paradoxical herniation were identified. The authors also sought to identify similar cases from the literature. Exact binomials were used to calculate 95% CIs. RESULTS None of 26 patients who underwent a lumbar puncture within 1 month of craniectomy deteriorated, whereas 2 of 10 who underwent a lumbar puncture 1 month afterward did so (20% [95% CI 2.4%–55.6%]). Similarly, after ventriculoperitoneal shunting, 3 of 10 patients deteriorated (30% [95% CI 6.7%–65.2%]). Timing of the procedure and the appearance of the skin flap were important factors in deterioration after lumbar puncture but not after ventriculoperitoneal shunting. A review of the literature identified 15 additional patients with paradoxical herniation provoked by lumbar puncture and 7 by ventriculoperitoneal shunting. CONCLUSIONS Lumbar puncture and ventriculoperitoneal shunting carry substantial risk when performed in a patient after decompressive craniectomy and before cranioplasty. When the condition that prompts decompression (such as brain swelling associated with stroke or trauma) requires time to resolve, risk is associated with lumbar puncture performed ≥ 1 month after decompressive craniectomy.

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“…Since Yamamura et al 15) reported in 1977, the syndrome of the sinking skin flap with neurological deterioration has been reported in the literature 2,5,7,8,11,12) . Many investigators have sought to explain the pathophysiology of this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

“…According to this theory, George et al 3) showed that there was a correlation between the restoration of the midline shift and the clinical improvement following cranioplasty in a series of angiographies. Recently, several authors 8,12) proposed that a negative gradient between atmospheric-and intracranial pressure, which is aggravated by changes in the CSF compartment following CSF hypovolemia to be the mechanism of neurological deterioration after craniectomy.…”

Section: Discussionmentioning

confidence: 99%