scholarly journals Paradoxical Brain Herniation after Cranioplasty: Secondary Sunken Flap Syndrome

2022 ◽  
Author(s):  
Navneet Singla ◽  
Archit Latawa
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Atmospheric Pressure ◽  
Brain Herniation ◽  
Delay In Diagnosis ◽  
Life Saving ◽  
Acute Neurological Deterioration ◽  
The Brain ◽  
Syndrome Of The Trephined

AbstractDecompressive craniectomy is a life-saving procedure done for innumerable etiologies. Though, not a technically demanding procedure, it has its own complications. Among many, sinking flap syndrome or syndrome of the trephined or paradoxical herniation of brain is frequently underestimated. It results from the pressure difference between the atmospheric pressure and the intracranial pressure causing the brain to shift inward at the craniectomy site. This can present with either nonspecific symptoms leading to delay in diagnosis or acute neurological deterioration, memory disturbances, weakness, confusion, lethargy, and sometimes death if not treated. Cranioplasty is a time validated procedure used to treat paradoxical brain herniation with good and early neurological recovery. We, here in, are going to describe a case report in which the paradoxical herniation occurred after cranioplasty which has not been described in literature.

Acute Paradoxical Herniation: A Case Report

2021 ◽  
Author(s):  
Vanessa Denny ◽  
Davina Shalev ◽  
Jahannaz Dastgir ◽  
Erin Johnson ◽  
Maria Escobar ◽  
...  
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Medical Therapy ◽  
Decompressive Craniectomy ◽  
Atmospheric Pressure ◽  
Rare Complication ◽  
Neurological Deficits ◽  
Increased Intracranial Pressure

AbstractDecompressive craniectomy is used to relieve acute increased intracranial pressure (ICP) when medical therapy has failed. Paradoxical herniation is a rare complication that occurs when the pressure of the intracranial contents falls abnormally below the atmospheric pressure. Symptoms often include neurological deficits, the etiology of which is often mistaken for elevated ICP. This diagnosis requires quick recognition, and treatment requires a change from ICP reduction therapies to those that increase the ICP, and ultimately cranioplasty.

scholarly journals Brain herniation in a patient with apparently normal intracranial pressure: a case report

2010 ◽  
Vol 4 (1) ◽  
Author(s):  
Mats B Dahlqvist ◽  
Robert H Andres ◽  
Andreas Raabe ◽  
Stephan M Jakob ◽  
Jukka Takala ◽  
...  
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Brain Herniation

Decompressive craniectomy for encephalitis with brain herniation: case report and review of the literature

2012 ◽  
Vol 154 (9) ◽  
pp. 1717-1724 ◽  
Author(s):  
Jordi Pérez-Bovet ◽  
Roser Garcia-Armengol ◽  
Maria Buxó-Pujolràs ◽  
Nadia Lorite-Díaz ◽  
Yislenz Narváez-Martínez ◽  
...  
Keyword(s):  
Case Report ◽  
Decompressive Craniectomy ◽  
Review Of The Literature ◽  
Brain Herniation

scholarly journals Decompressive Craniectomy for Elevated Intracranial Pressure and Its Effect on the Cumulative Ischemic Burden and Therapeutic Intensity Levels After Severe Traumatic Brain Injury

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1111-1119 ◽  
Author(s):  
Gregory M. Weiner ◽  
Michelle R. Lacey ◽  
Larami Mackenzie ◽  
Darshak P. Shah ◽  
Suzanne G. Frangos ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Intensity Level ◽  
Before And After ◽  
Severe Tbi ◽  
Therapeutic Intensity ◽  
The Brain

Abstract BACKGROUND Increased intracranial pressure (ICP) can cause brain ischemia and compromised brain oxygen (PbtO2 ≤ 20 mm Hg) after severe traumatic brain injury (TBI). OBJECTIVE We examined whether decompressive craniectomy (DC) to treat elevated ICP reduces the cumulative ischemic burden (CIB) of the brain and therapeutic intensity level (TIL). METHODS Ten severe TBI patients (mean age, 31.4 ± 14.2 years) who had continuous PbtO2 monitoring before and after delayed DC were retrospectively identified. Patients were managed according to the guidelines for the management of severe TBI. The CIB was measured as the total time spent between a PbtO2 of 15 to 20, 10 to 15, and 0 to 10 mm Hg. The TIL was calculated every 12 hours. Mixed-effects models were used to estimate changes associated with DC. RESULTS DC was performed on average 2.8 days after admission. DC was found to immediately reduce ICP (mean [SEM] decrease was 7.86 mm Hg [2.4 mm Hg]; P = .005). TIL, which was positively correlated with ICP (r = 0.46, P ≤ .001), was reduced within 12 hours after surgery and continued to improve within the postsurgical monitoring period (P ≤ .001). The duration and severity of CIB were significantly reduced as an effect of DC in this group. The overall mortality rate in the group of 10 patients was lower than predicted at the time of admission (P = .015). CONCLUSION These results suggest that a DC for increased ICP can reduce the CIB of the brain after severe TBI. We suggest that DC be considered early in a patient's clinical course, particularly when the TIL and ICP are increased.

scholarly journals Decompressive Craniectomy for Acute Stroke: The Good, the Bad, and the Ugly of it

2014 ◽  
Vol 21 (3) ◽  
pp. 349-352
Author(s):  
Dhaval Shukla ◽  
Amit Agrawal
Keyword(s):  
Acute Stroke ◽  
Decompressive Craniectomy ◽  
Salvage Therapy ◽  
Medical Management ◽  
Clinical Signs ◽  
Brain Herniation ◽  
Severe Morbidity ◽  
Maximum Benefit ◽  
Life Saving ◽  
Restorative Surgery

Abstract Large hemispheric infarctions have malignant course and constitute a major cause of severe morbidity and mortality after stroke. The medical management is usually not effective in these cases. Decompressive craniectomy is a salvage therapy for medically refractory ICP. This paper discusses the merits and demerits of decompressive craniectomy for large hemispheric infarctions. Hemicraniectomy is a life-saving but non-restorative surgery. Surgery should be done before clinical signs of brain herniation to obtain maximum benefit. The relatives of the patient should be explained clearly about possibility of survival with disability before offering the surgery.

scholarly journals Cortical Pressure Injury: A Hypothesis to Explain the Incongruity of Clinical and Radiologic Improvement in Decompressive Craniectomy

2019 ◽  
Vol 08 (03) ◽  
pp. 188-190
Author(s):  
Sudip Kumar Sengupta ◽  
Harjinder Singh Bhatoe
Keyword(s):  
Intracranial Pressure ◽  
Clinical Outcome ◽  
Decompressive Craniectomy ◽  
Cranial Vault ◽  
Intracranial Volume ◽  
Anatomy And Physiology ◽  
Pressure Injury ◽  
The Brain ◽  
Shared Problem

AbstractIt has astonished neuroscientists since the advent of decompressive craniectomy as to why a seemingly successfully achieved goal of reduction in intracranial pressure (ICP), by removing a portion of the cranial vault and the resultant intracranial volume augmentation, fails to give the desired beneficial clinical outcome in every case and in fact, at times, proves to be deleterious in some conditions with a shared problem of refractory raised ICP. The authors propose a hypothesis based on the understanding of the anatomy and physiology of the brain that can explain the fallacy.

scholarly journals Contralateral extradural hematoma following decompressive craniectomy for acute subdural hematoma (the value of intracranial pressure monitoring): a case report

2014 ◽  
Vol 8 (1) ◽  
Author(s):  
Lucas Crociati Meguins ◽  
Gustavo Botelho Sampaio ◽  
Eduardo Cintra Abib ◽  
Rodrigo Antônio Rocha da Cruz Adry ◽  
Richam Faissal El Hossain Ellakkis ◽  
...  
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Subdural Hematoma ◽  
Intracranial Pressure Monitoring ◽  
Acute Subdural Hematoma ◽  
Pressure Monitoring ◽  
Extradural Hematoma

Functional Recovery after Decompressive Craniectomy for Cerebral Infarction

Neurosurgery ◽  
1988 ◽  
Vol 23 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Douglas Kondziolka ◽  
Mahmood Fazl
Keyword(s):  
Intracranial Pressure ◽  
Cerebral Infarction ◽  
Brain Stem ◽  
Functional Recovery ◽  
Decompressive Craniectomy ◽  
Cerebral Edema ◽  
Increased Intracranial Pressure ◽  
Life Saving ◽  
Impending Death ◽  
Conventional Medical Therapy

ABSTRACT There is continuing controversy about the benefits of decompressive craniectomy in the treatment of lesions causing increased intracranial pressure (ICP) and brain edema. Laboratory work has shown a decrease in ICP after craniectomy, but also a paradoxical enhancement in the formation of underlying cerebral edema, which may act to the detriment of the patient. Since Rengachary et al. advocated craniectomy for massive cerebral infarction and reported their group of three patients, we have managed five patients with acute supratentorial cerebral infarction who progressed to uncal herniation and impending death from raised ICP and brain stem compression. All were treated with frontotemporal craniectomy after conventional medical therapy failed to achieve a response. All patients survived and are walking, despite a paresis appropriate to their original stroke. Two have returned to work. Good results with supratentorial craniectomy after infarction show that this procedure is life-saving and can also give acceptable functional recovery.

scholarly journals Massive Temporalis Muscle Swelling after Decompressive Craniectomy: Case Report

2020 ◽  
Vol 2 (3) ◽  
pp. 32-34
Author(s):  
Dinesh Kumar Thapa ◽  
Pankaj Raj Nepal ◽  
Robin Bhattarai ◽  
Jagat Narayan Rajbanshi ◽  
Navin Kumar Yadav
Keyword(s):  
Case Report ◽  
Decompressive Craniectomy ◽  
Surgical Procedure ◽  
Mass Effect ◽  
Brain Herniation ◽  
Midline Shift ◽  
Brain Swelling ◽  
Temporalis Muscle ◽  
Significant Mass Effect ◽  
Significant Mass

 Background: Decompressive Craniectomy is a surgical procedure in neurosurgery to handle brain swelling subsequent to trauma, vascular insult, or tumor. There are different techniques and measurements of decompressive craniectomy performed worldwide. We follow the regular trauma flap involving fronto-temporo-parietal craniectomy. There have been many complications seen in these procedures, like brain herniation, malignant swelling, hydrocephalus, infection, etc. But we have encountered quite rare complications of decompressive craniectomy which had massive swelling of the temporalis muscle leading to significant mass effect and midline shift.

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