TITLE:
Persistent Brain Herniation after Decompressive Hemicraniectomy: Role of Lumbar Drainage for Cranioplasty. Case Report
AUTHORS:
Mario Francesco Fraioli, Francesco Marzetti, Bernardo Fraioli, Pierpaolo Lunardi
KEYWORDS:
Decompressive Hemicraniectomy, Persistent Brain Herniation, Lumbar Drainage, Cranioplasty
JOURNAL NAME:
Open Access Library Journal,
Vol.3 No.1,
January
25,
2016
ABSTRACT: Hydrocephalus and ex-vacuo ventricular dilatations which cause persistent
brain herniation with impossibility to perform cranioplasty, are well known
late complications after decompressive hemicraniectomy; concerning the
physiopathologic mechanism leading to these complications, there are several
theories. We report the particular case of a patient suffering from persistent
brain herniation after decompressive hemicraniectomy, due to development of
subdural hygroma, intraparenchymal multiple liquoral cysts and only mild
enlargement of frontal horn of right lateral ventricle. A fifty-five years old
male patient was treated with decompressive right hemicraniectomy for acute
hemispheric swelling consequent to right internal carotid artery dissecation. After
several months, evaluating the patient for cranioplasty, brain herniation was
clinically evident and brain MRI confirmed it due to subdural hygroma,
intraparenchymal multiple liquoral cysts and mild enlargement of frontal horn
of right lateral ventricle. According to several reported theories,
communication between right frontal horn of lateral ventricle, intraparenchymal
liquoral cysts and subdural hygroma was supposed, and CSF lumbar drainage was
placed. Regression of brain herniation was achieved and cranioplasty was
possible; after few days lumbar drainage was removed: neither operative, nor
short and long follow-up period complications were observed. Temporary CSF
lumbar drainage resulted effective to obtain regression of a particular case of
persistent brain herniation developed after decompressive hemicraniectomy;
moreover this safe procedure, not previously described to forerun cranioplasty
surgery to our knowledge, allowed performing cranioplasty in absence of
complications and avoiding temporary or permanent ventricular shunts which
present a major rate of risks and possible complications.