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

Creutzfeldt, Claire J.; Vilela, Marcelo D.; Longstreth, W. T.

doi:10.3171/2014.11.jns141810

Cited by 25 publications

(31 citation statements)

References 22 publications

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“…It occurs from several weeks to months after DC 58). After craniectomy, the cranium does not maintain rigid structure.…”

Section: Discussionmentioning

confidence: 99%

“…A known cause is local in-folding of the scalp or scarring at the craniectomy site between the overlying skin and dura, which exerts direct pressure on the brain 11). Atmospheric pressure also exerts a force against the concave sinking skin flap and underlying brain tissue, influencing cerebrospinal fluid (CSF) flow 15). There are many different neurologic symptoms of SSFS that usually resolves after cranioplasy 39)…”

Section: Introductionmentioning

confidence: 99%

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Intracerebral Hemorrhagic Infarction after Cranioplasty in a Patient with Sinking Skin Flap Syndrome

Han

Lee

2016

Korean J Neurotrauma

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The sinking skin flap syndrome (SSFS) is a rare complication after a large craniectomy. Hemorrhage infarction after a cranioplasty is a very rare complication with only 4 cases to date. We report a case of the patient who underwent an autologous cranioplasty to treat SSFS that developed intracerebral hemorrhage infarction. A 20-year-old male was admitted to our emergency department with stuporous mentality. Emergent decompressive craniectomy (DC) have done. He had suffered from SSFS and fever of unknown origin (FUO) since DC. After 7 months of craniectomy, cranioplasty was done. After 1 day of surgery, acute infarction with hemorrhagic transformation involved left cerebral hemisphere. We controlled increased intracranial pressure by using osmotic diuretics, steroid and antiepileptic drugs. After 14 day of surgery, he improved neurological symptoms and he had not any more hyperthermia. Among several complication of large cranioplasty only 4 cases of intracerebral hemorrhagic infarction due to reperfusion injury has been reported. In this case, unstable autoregulation system made brain hypoxic damage and then reperfusion and recanalization of cerebral vessels resulted in intracerebral hemorrhagic infarction. 7 month long FUO was resolved by cranioplasty.

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“…It occurs from several weeks to months after DC 58). After craniectomy, the cranium does not maintain rigid structure.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intracerebral Hemorrhagic Infarction after Cranioplasty in a Patient with Sinking Skin Flap Syndrome

Han

Lee

2016

Korean J Neurotrauma

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“…The same series identified herniation in 30% of patients undergoing shunting, regardless of the timing. 106 Another series identified neurologic deterioration in a quarter of patients undergoing lumbar drainage following DC, with one patient dying as a result. 107 Management of paradoxical herniation includes maneuvers such as bed rest with Trendelenburg position, hydration, and cessation of CSF diversion, if possible.…”

Section: Syndrome Of Trephined and Paradoxical Herniationmentioning

confidence: 99%

Decompressive Craniectomy in Neurocritical Care

et al. 2016

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Neurosurgeons increasingly use decompressive craniectomy (DC) in neurocritical care. In this review, the authors summarize the topic of DC for the neurointensivist. Following a brief overview of the procedure, the major indications for the procedure are described. This includes a review of the literature regarding well-established indications, such as infarction and traumatic brain injury, as well as lesser known indications, including intracerebral hemorrhage, ruptured cerebrovascular malformations, sinus thrombosis, and infection. Complications unique to DC, specifically syndrome of the trephined, hygroma, and hydrocephalus, also are reviewed with a discussion of their management, both in the immediate and the postoperative period.

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“…On the other hand, CSF disturbances after DC could be caused by intracranial hypotension and the effect of atmospheric pressure [2,5,10]. After a large bone flap is removed from the cranium, atmospheric pressure is applied onto the brain parenchyma producing a significant alteration in the intracranial dynamics [2].…”

mentioning

confidence: 99%

“…SE could also be associated with other life-threatening complications of DC due to the effect of atmospheric pressure such as paradoxical herniation syndrome and sinking brain syndrome; the mainstay of therapy for these conditions is a cranioplasty in order to eliminate the effect of atmospheric pressure improving intracranial dynamics [3,13,[19][20][21]. CSF diversion procedures or even a lumbar puncture in patients with skull defects are extremely hazardous and may aggravate the atmospheric pressure gradient leading to brain herniation [5,13]. Early cranioplasty with or without CSF shunt has been advocated for patients with CSF disturbances [4,18].…”

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confidence: 99%

Subdural effusion in decompressive craniectomy

Avecillas-Chasín

2015

Acta Neurochir

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Dear Editor I have read with great interest the article BAnother treatment choice for subdural effusion with ventricle dilation^by Fang et al. The authors report their experience treating subdural effusions (SE) in two patients with decompressive craniectomy (DC) using lumboperitoneal shunt [7]. Traumatic SE is an alteration of the cerebrospinal fluid (CSF) circulation that is associated with traumatic brain injury (TBI). However, SE has also been associated with DC for traumatic and non-traumatic conditions [11,18,22]. The underlying pathogenesis of SE in both conditions (DC and TBI) is different; therefore, the management of this condition could be largely different [3,10,13].Traumatic SE is a relatively common complication of TBI with a benign course in the majority of cases [23]. As the authors mentioned, the origin of TSE has been related with a tear in the subarachnoid layer probably due to the head trauma producing egress of the CSF to the subdural space in a valve-like manner [1,7,23]. Other theories have been also proposed such as the presence of a neomembrane with increased capillary permeability leading to the development of the SE [1,8]. Furthermore, due to the head trauma or disturbances in CSF absorption, alterations in intracranial compliance could also contribute to this complication [9,12,13,15]. I agree with the authors that most SE cases are self-limited, but in rare cases SE manifests with mass effect and ventricular dilation and even in those cases the surgical management is variable [4,16,17,23]. Accordingly, it is not clear if shunting procedures are the Bonly cure^for this type of CSF alterations in the setting of DC for TBI, as stated by the authors [7].On the other hand, CSF disturbances after DC could be caused by intracranial hypotension and the effect of atmospheric pressure [2, 5, 10]. After a large bone flap is removed from the cranium, atmospheric pressure is applied onto the brain parenchyma producing a significant alteration in the intracranial dynamics [2]. CSF absorption is carried out in a pressure-dependant manner through the arachnoid granulations with a directly proportional relationship between subarachnoid pressure and CSF absorption rate [14,18]. Therefore, pressurerelated alterations take place into the subarachnoid space with the subsequent alteration of the CSF absorption. This mechanism is aggravated by any communication between the subdural and subarachnoid space [10] producing the SE after DC. As the authors stated, the SE acts as compensatory mechanism of the disturbed CSF circulation due to the subarachnoid/subdural gradient. Furthermore, ventricular dilation may also occur by the same mechanism [6,18], and this event may further disturb the CSF dynamics thus increasing the subarachnoid/subdural gradient. SE is not a common finding in patients who have undergone DC for traumatic and non-traumatic conditions [1,11,21]. Therefore, other factors may play a role in the development of SE after DC.Despite that the authors report a good outcome of their patients, it is ...

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

Cited by 25 publications

References 22 publications

Intracerebral Hemorrhagic Infarction after Cranioplasty in a Patient with Sinking Skin Flap Syndrome

Intracerebral Hemorrhagic Infarction after Cranioplasty in a Patient with Sinking Skin Flap Syndrome

Decompressive Craniectomy in Neurocritical Care

Subdural effusion in decompressive craniectomy

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