J Korean Neurosurg Soc.  2006 Jul;40(1):51-53.

Paradoxical Herniation after Decompressive Craniectomy for Acute Subdural Hematoma

• Cho H
• Kim CH
• Kim JH
• Kim JM

Abstract

Decompressive craniectomy is usually performed to relieve raised intracranial pressure(ICP) caused by various intracranial lesions. A 67-year-old man presented with acute subdural hematoma and traumatic intracerebral hematoma. The patient underwent a decompressive craniectomy. Four weeks later, the patient presented with acute neurological deterioration. Brain computed tomographic(CT) scans revealed the marked concavity of the brain at the site of the craniectomy and associated with midline shift which was reversed by cranioplasty. We report an unusual case of cerebral herniation from intracranial hypotension after decompressive craniectomy for a traumatic subdural hematoma. The cranioplasty may be helpful to prevent paradoxial cerebral herniation.

Keyword

Cerebral herniation; Cranioplasty; Decompressive craniectomy; Subdural hematoma

MeSH Terms

Aged
Brain
Decompressive Craniectomy*
Hematoma
Hematoma, Subdural
Hematoma, Subdural, Acute*
Humans
Intracranial Hypotension