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Journal of Korean Neurosurgical Society 2006;40(1): 51-53.
Paradoxical Herniation after Decompressive Craniectomy for Acute Subdural Hematoma.
Hyun Cho, Choong Hyun Kim, Jae Hoon Kim, Jae Min Kim
Department of Neurosurgery, School of Medicine, Hanyang University, Guri Hospital, Guri, Korea. kch5142@hanyang.ac.kr
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.
Key Words: Cerebral herniation; Cranioplasty; Decompressive craniectomy; Subdural hematoma
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