Symptomatic patients after craniectomy

Schiffer, J; Gur, Ruth; Nisim, Uzi; Pollak, Lea

doi:10.1016/s0090-3019(96)00376-x

Cited by 111 publications

(62 citation statements)

References 13 publications

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“…She subsequently deteriorated slowly but showed marked improvement after cranioplasty performed approximately 1 year after her initial surgery. In another series reported by Schiffer et al, 15 a patient deteriorated more immediately after receiving a ventriculoperitoneal shunt and improved after cranioplasty (Case 4). Oh et al 13 described deterioration after ventriculoperitoneal shunting in 2 of 13 patients with hydrocephalus who were convex at the craniotomy site before the procedure.…”

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confidence: 88%

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Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture or ventriculoperitoneal shunting

Creutzfeldt¹,

Vilela

Longstreth

2015

JNS

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OBJECT Two patients who underwent decompressive craniectomy after head trauma deteriorated secondary to paradoxical herniation, one after lumbar puncture and the other after ventriculoperitoneal shunting. They motivated the authors to investigate further provoked paradoxical herniation. METHODS The authors reviewed the records of 205 patients who were treated at a single hospital with decompressive craniectomy for head trauma to identify those who had had lumbar puncture performed or a ventriculoperitoneal shunt placed after craniectomy but before cranioplasty. Among the patients who met these criteria, those with provoked paradoxical herniation were identified. The authors also sought to identify similar cases from the literature. Exact binomials were used to calculate 95% CIs. RESULTS None of 26 patients who underwent a lumbar puncture within 1 month of craniectomy deteriorated, whereas 2 of 10 who underwent a lumbar puncture 1 month afterward did so (20% [95% CI 2.4%–55.6%]). Similarly, after ventriculoperitoneal shunting, 3 of 10 patients deteriorated (30% [95% CI 6.7%–65.2%]). Timing of the procedure and the appearance of the skin flap were important factors in deterioration after lumbar puncture but not after ventriculoperitoneal shunting. A review of the literature identified 15 additional patients with paradoxical herniation provoked by lumbar puncture and 7 by ventriculoperitoneal shunting. CONCLUSIONS Lumbar puncture and ventriculoperitoneal shunting carry substantial risk when performed in a patient after decompressive craniectomy and before cranioplasty. When the condition that prompts decompression (such as brain swelling associated with stroke or trauma) requires time to resolve, risk is associated with lumbar puncture performed ≥ 1 month after decompressive craniectomy.

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confidence: 88%

“…1,5,15 Low rather than high intracranial pressures ensue, which result in sinking of the skin flap and paradoxical herniation. Because the herniation relates to low pressures, treatments aimed at lowering intracranial pressures may worsen the situation.…”

mentioning

confidence: 99%

Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture or ventriculoperitoneal shunting

Creutzfeldt¹,

Vilela

Longstreth

2015

JNS

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“…Since Yamamura et al 15) reported in 1977, the syndrome of the sinking skin flap with neurological deterioration has been reported in the literature 2,5,7,8,11,12) . Many investigators have sought to explain the pathophysiology of this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

“…Decompressive craniectomy is widely used in neurosurgical field for the relief of intractable intracranial hypertension in patients with head injury, acute stroke, and severe brain edema after intracranial procedure 7,11) . After craniectomy, some patients may suffer from hydrocephalus for which cerebrospinal fluid (CSF) diversion, including V-P shunt, lumbar drainage, and extraventricular drainage are needed 9,10) .…”

Section: Introductionmentioning

confidence: 99%

"Syndrome of the Sinking Skin-Flap" Secondary to the Ventriculoperitoneal Shunt after Craniectomy

Han

Kim

Kang

et al. 2008

J Korean Neurosurg Soc

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“…The syndrome is characterized by progressive neurological deterioration of the patient and requires cranioplasty. 5 The aim of this case report is to emphasize a late complication of a diastatic linear fracture, GSF, presented with appearance of SSFS. The patient we reported had an unusual GSF, the scalp overlying the bone defect displayed orthostatic sinking SSFS.…”

Section: A Case Of Growing Skull Fracture Withmentioning

confidence: 99%

A Case of Growing Skull Fracture with Appearance of the Sinking Skin Flap Syndrome

Ercan¹,

Şentürk²,

Güzel³

et al. 2011

Turkiye Klinikleri J Med Sci

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1262growing skull fracture (GSF) is a progressive enlarging diastatic fracture, which occurs as a rare complication of head trauma almost exclusively in infants and children.1 Brain contusion, porencephalic cyst formation and alterations of cerebrospinal fluid circulation generally accompany the dural defect. The incidence of GSF ranges from 0.05 to 1.6% of pediatric skull fractures, and the patients generally present with scalp swelling and neurological deficits. 2,3 It is known that the scalp overlying the defect can appear flat or sunken.2,4 However, orthostatic sinking of the scalp over the GSF has not been reported. A Case of Growing Skull Fracture withAppearance of the Sinking Skin Flap Syndrome A AB BS S T TR RA AC CT T A growing skull fracture is a late complication of a traumatic linear skull fracture. Untreated growing skull fractures can be associated with headache and progressive neurological deficits. In this case report, an unusual growing skull fracture mimicking sinking skin flap syndrome is presented. An 11-year-old girl, who had had a linear skull fracture 6 years previously, presented with headache, progressive left hemiparesis and right parietal scalp swelling on supine position. The scalp overlying the bone defect was sinking on upright position like the sinking skin flap syndrome. The growing skull fracture, revealed on the plain X-ray and computed tomography, was treated by duraplasty and cranioplasty with methylmetacrilate. The symptom of headache resolved and her walk improved after the treatment.

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Symptomatic patients after craniectomy

Cited by 111 publications

References 13 publications

Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture or ventriculoperitoneal shunting

Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture or ventriculoperitoneal shunting

"Syndrome of the Sinking Skin-Flap" Secondary to the Ventriculoperitoneal Shunt after Craniectomy

A Case of Growing Skull Fracture with Appearance of the Sinking Skin Flap Syndrome

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