- Department of Neurosurgery, Shimada Municipal Hospital, Shimada City, Shizuoka, Japan
Department of Neurosurgery, Shimada Municipal Hospital, Shimada City, Shizuoka, Japan
DOI:10.4103/sni.sni_137_17Copyright: © 2017 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Yuta Kaneshiro, Keiji Murata, Shigeru Yamauchi, Yumiko Urano. Fatal cerebral swelling immediately after cranioplasty: A case report. 25-Jul-2017;8:156
How to cite this URL: Yuta Kaneshiro, Keiji Murata, Shigeru Yamauchi, Yumiko Urano. Fatal cerebral swelling immediately after cranioplasty: A case report. 25-Jul-2017;8:156. Available from: http://surgicalneurologyint.com/surgicalint-articles/fatal-cerebral-swelling-immediately-after-cranioplasty-a-case-report/
Background:Cranioplasty is a standard neurosurgical procedure which is performed after decompressive craniotomy. Fatal complications associated with this procedure are not well documented. Here, we report a case of fatal cerebral swelling after cranioplasty and discuss the possible mechanism of this complication.
Case Description:A 64-year-old man was admitted with the diagnosis of cerebral hemorrhage, and emergency surgery for hemorrhage removal and decompressive craniotomy were performed. One month after surgery, cranioplasty was performed using a titanium mesh plate. Sixteen hours after the surgery, the patient became comatose with bilateral dilated pupils followed by blood pressure lowering. Computed tomography of the brain showed bilateral massive cerebral edema. The titanium mesh plate was immediately removed, however, the patient’s neurological condition did not recover and he died 7 days after the surgery. We speculated that the negative pressure difference and increase in cerebral blood flow after cranioplasty may have attributed to the fatal cerebral swelling.
Conclusion:Fatal cerebral swelling after cranioplasty is a rare but devastating complication. Although it is rare, neurosurgeons should keep in mind that this fatal complication can follow cranioplasty.
Keywords: Cerebral edema, cerebral swelling, cranioplasty, decompressive craniotomy, fatal complication
Cranioplasty is usually performed after decompressive craniotomy for several neurological conditions, including traumatic injury, brain infarction, cerebral hemorrhage, and subarachnoid hemorrhage. Although cranioplasty is a standard neurosurgical procedure, it is associated with a high complication rate owing to concerns such as wound infection, bone resorption, and epidural or subdural hematoma.[
A 64-year-old man was admitted to the Department of Neurosurgery after sudden onset of consciousness disturbance. On admission, the patient was comatose with decerebrate postures. Computed tomography (CT) of the brain showed a massive left intracerebral hemorrhage accompanying intraventricular hemorrhage [
One month after the surgery, consciousness and neurological status of the patient gradually improved and CT showed remarkable brain sinking [
Cranioplasty is performed not only to address the cosmetic problem but also to improve the neurological status of patients who have undergone decompressive craniotomy.[
The exact mechanism underlying massive cerebral swelling after cranioplasty has not yet been fully understood. Lee et al.[
In the present case, we speculated two mechanisms that may have attributed to fatal cerebral swelling. First, the shrinking brain before cranioplasty may have changed the brain compliance because of long-term compression under the atmospheric pressure. Therefore, negative pressure difference owing to the elimination of atmospheric pressure in combination with the negative pressure applied by the closed subgaleal suction drain may have easily induced the brain shift, as previously reported.[
Fatal cerebral swelling after cranioplasty is a rare but devastating complication. Although it is rare, neurosurgeons should keep in mind that this fatal complication can follow cranioplasty.
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Conflicts of interest
There are no conflicts of interest.
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