Cargando…

Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report

BACKGROUND: Sinking skin flap syndrome or paradoxical brain herniation is an uncommon neurosurgical complication, which usually occurs in the chronic phase after decompressive craniectomy. We report a unique case presenting with these complications immediately after decompressive craniectomy for sev...

Descripción completa

Detalles Bibliográficos
Autores principales: Hiruta, Ryo, Jinguji, Shinya, Sato, Taku, Murakami, Yuta, Bakhit, Mudathir, Kuromi, Yosuke, Oda, Keiko, Fujii, Masazumi, Sakuma, Jun, Saito, Kiyoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744802/
https://www.ncbi.nlm.nih.gov/pubmed/31528417
http://dx.doi.org/10.25259/SNI-235-2019
_version_ 1783451450839400448
author Hiruta, Ryo
Jinguji, Shinya
Sato, Taku
Murakami, Yuta
Bakhit, Mudathir
Kuromi, Yosuke
Oda, Keiko
Fujii, Masazumi
Sakuma, Jun
Saito, Kiyoshi
author_facet Hiruta, Ryo
Jinguji, Shinya
Sato, Taku
Murakami, Yuta
Bakhit, Mudathir
Kuromi, Yosuke
Oda, Keiko
Fujii, Masazumi
Sakuma, Jun
Saito, Kiyoshi
author_sort Hiruta, Ryo
collection PubMed
description BACKGROUND: Sinking skin flap syndrome or paradoxical brain herniation is an uncommon neurosurgical complication, which usually occurs in the chronic phase after decompressive craniectomy. We report a unique case presenting with these complications immediately after decompressive craniectomy for severe traumatic brain injury. CASE DESCRIPTION: A 65-year-old man had a right acute subdural hematoma (SDH), contusion of the right temporal lobe, and diffuse traumatic subarachnoid hemorrhage with midline shift to the left side. He underwent an emergency evacuation of the right SDH with a right decompressive frontotemporal craniectomy. Immediately after the operation, his neurological and computed tomography (CT) findings had improved. However, within 1 h after the surgery, his neurological signs deteriorated. An additional follow-up CT showed a marked midline shift to the left, i.e., paradoxical brain herniation, and his skin flap overlying the decompressive site was markedly sunken. We immediately performed an urgent cranioplasty with the right temporal lobectomy. He responded well to the procedure. We suspected that a cerebrospinal fluid leak had caused this phenomenon. CONCLUSION: Decompressive craniectomy for severe traumatic brain injury can lead to sinking skin flap syndrome and/or paradoxical brain herniation even in the acute phase. We believe that immediate cranioplasty allows the reversal of such neurosurgical complications.
format Online
Article
Text
id pubmed-6744802
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Scientific Scholar
record_format MEDLINE/PubMed
spelling pubmed-67448022019-09-16 Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report Hiruta, Ryo Jinguji, Shinya Sato, Taku Murakami, Yuta Bakhit, Mudathir Kuromi, Yosuke Oda, Keiko Fujii, Masazumi Sakuma, Jun Saito, Kiyoshi Surg Neurol Int Case Report BACKGROUND: Sinking skin flap syndrome or paradoxical brain herniation is an uncommon neurosurgical complication, which usually occurs in the chronic phase after decompressive craniectomy. We report a unique case presenting with these complications immediately after decompressive craniectomy for severe traumatic brain injury. CASE DESCRIPTION: A 65-year-old man had a right acute subdural hematoma (SDH), contusion of the right temporal lobe, and diffuse traumatic subarachnoid hemorrhage with midline shift to the left side. He underwent an emergency evacuation of the right SDH with a right decompressive frontotemporal craniectomy. Immediately after the operation, his neurological and computed tomography (CT) findings had improved. However, within 1 h after the surgery, his neurological signs deteriorated. An additional follow-up CT showed a marked midline shift to the left, i.e., paradoxical brain herniation, and his skin flap overlying the decompressive site was markedly sunken. We immediately performed an urgent cranioplasty with the right temporal lobectomy. He responded well to the procedure. We suspected that a cerebrospinal fluid leak had caused this phenomenon. CONCLUSION: Decompressive craniectomy for severe traumatic brain injury can lead to sinking skin flap syndrome and/or paradoxical brain herniation even in the acute phase. We believe that immediate cranioplasty allows the reversal of such neurosurgical complications. Scientific Scholar 2019-05-10 /pmc/articles/PMC6744802/ /pubmed/31528417 http://dx.doi.org/10.25259/SNI-235-2019 Text en Copyright: © 2019 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 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.
spellingShingle Case Report
Hiruta, Ryo
Jinguji, Shinya
Sato, Taku
Murakami, Yuta
Bakhit, Mudathir
Kuromi, Yosuke
Oda, Keiko
Fujii, Masazumi
Sakuma, Jun
Saito, Kiyoshi
Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report
title Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report
title_full Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report
title_fullStr Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report
title_full_unstemmed Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report
title_short Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report
title_sort acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744802/
https://www.ncbi.nlm.nih.gov/pubmed/31528417
http://dx.doi.org/10.25259/SNI-235-2019
work_keys_str_mv AT hirutaryo acuteparadoxicalbrainherniationafterdecompressivecraniectomyforseveretraumaticbraininjuryacasereport
AT jingujishinya acuteparadoxicalbrainherniationafterdecompressivecraniectomyforseveretraumaticbraininjuryacasereport
AT satotaku acuteparadoxicalbrainherniationafterdecompressivecraniectomyforseveretraumaticbraininjuryacasereport
AT murakamiyuta acuteparadoxicalbrainherniationafterdecompressivecraniectomyforseveretraumaticbraininjuryacasereport
AT bakhitmudathir acuteparadoxicalbrainherniationafterdecompressivecraniectomyforseveretraumaticbraininjuryacasereport
AT kuromiyosuke acuteparadoxicalbrainherniationafterdecompressivecraniectomyforseveretraumaticbraininjuryacasereport
AT odakeiko acuteparadoxicalbrainherniationafterdecompressivecraniectomyforseveretraumaticbraininjuryacasereport
AT fujiimasazumi acuteparadoxicalbrainherniationafterdecompressivecraniectomyforseveretraumaticbraininjuryacasereport
AT sakumajun acuteparadoxicalbrainherniationafterdecompressivecraniectomyforseveretraumaticbraininjuryacasereport
AT saitokiyoshi acuteparadoxicalbrainherniationafterdecompressivecraniectomyforseveretraumaticbraininjuryacasereport