Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Unexpected Severe Cerebral Edema after Cranioplasty : Case Report and Literature Review

  • Lee, Gwang Soo (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Park, Sukh Que (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Kim, Rasun (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Cho, Sung Jin (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine)
  • Received : 2014.06.20
  • Accepted : 2014.09.26
  • Published : 2015.07.28
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Abstract

This report details a case of unexpected, severe post-operative cerebral edema following cranioplasty. We discuss the possible pathological mechanisms of this complication. A 50-year-old female was admitted to our department with sudden onset of stuporous consciousness. A brain computed tomography (CT) revealed a subarachnoid hemorrhage with intracranial hemorrhage and subdural hematoma. Emergency decompressive craniectomy and aneurysmal neck clipping were performed. Following recovery, the decision was made to proceed with an autologous cranioplasty. The cranioplasty procedure was free of complications. An epidural drain was placed and connected to a suction system during skin closure to avoid epidural blood accumulation. However, following the procedure, the patient had a seizure in the recovery room. An emergency brain CT scan revealed widespread cerebral edema, and the catheter drain was clamped. The increased intracranial pressure and cerebral edema were controlled with osmotic diuretics, corticosteroids, and antiepileptic drugs. The edema slowly subsided, but new low-density areas were noted in the brain on follow-up CT 1 week later. We speculated that placing the epidural drain on active suction may have caused an acute decrease in intracranial pressure and subsequent rapid expansion of the brain, which impaired autoregulation and led to reperfusion injury.

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References

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