두개골 성형술 후 회복된 경막하수종을 동반한 역설적 뇌탈출 1례

Abstract

Decompressive craniectomy is usually performed to relieve increased intracranial pressure (ICP) in patients caused by various intracranial lesions. The sinking skin flap syndrome is a rare complication after a large craniectomy, which may progress to paradoxical herniation as a consequence of atmospheric pressure exceeding intracranial pressure. A 68-year-old man presented with acute subdural hematoma and traumatic intracerebral hematoma after head injury. The patient underwent a decompressive craniectomy and removal of the subdural hematoma. The 3 weeks later, the patient presented with acute neurological deterioration. Local examination showed the depressed brain and scalp flap. Brain computed tomographic (CT) scans showed subdural hygroma in the site of the craniectomy with displacement of the midline structures, which was reversed by the cranioplasty. Cranioplasty has been affected on the overall recovery of the patient. We report an unusual case of the paradoxical herniation with subdural hygroma after decompressvie craniectomy for a traumatic subdural hematoma. The cranioplasty might be sufficient to treat paradoxical herniation.