Massive Brain Swelling after Cranioplasty: A Case Report

Abstract

Background Cranioplasty is a common procedure in neurosurgery. It is usually performed following decompressive craniectomy (DC). However, complications may occur after the operation, such as massive brain swelling. Up to now, far too little attention has been given to this severe complication. We report one case of fatal cerebral swelling after cranioplasty and analyze the possible mechanism of this complication.

Case Description The patient was a 40-year-old man who had a severe right basal ganglia cerebral hemorrhage and underwent DC ∼ 2 months before. One day before scheduled cranioplasty, a lumbar cerebrospinal fluid drainage was placed. The cranioplasty itself was uneventful. However, he gradually fell into a coma, and his right pupil was moderately dilated 20 hours after the surgery. A brain computed tomography (CT) scan indicated massive right cerebral edema with compressed right midbrain. The patient did not regain consciousness, and he remained quadriplegic.

Conclusion It is necessary to increase awareness of complications of cranioplasty in high-risk patients. The lessons learned from this case include avoiding excessive drainage of cerebrospinal fluid. Patients with low-density lesions in the brain need to be treated with caution. Once the CT scan shows massive cerebral swelling, the patient has a poor prognosis.

Keywords

cranioplasty - malignant cerebral swelling - massive brain swelling - low-density lesions - decompressive craniectomy

• References

• 1 Piazza M, Grady MS. Cranioplasty. Neurosurg Clin N Am 2017; 28 (02) 257-265
• 2 Gooch MR, Gin GE, Kenning TJ, German JW. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 2009; 26 (06) E9
• 3 Zanaty M, Chalouhi N, Starke RM. , et al. Complications following cranioplasty: incidence and predictors in 348 cases. J Neurosurg 2015; 123 (01) 182-188
• 4 Honeybul S, Ho KM. Cranioplasty: morbidity and failure. Br J Neurosurg 2016; 30 (05) 523-528
• 5 Robles LA, Cuevas-Solórzano A. Massive brain swelling and death after cranioplasty: a systematic review. World Neurosurg 2018; 111: 99-108
• 6 Santana-Cabrera L, Pérez-Ortiz C, Rodríguez-Escot C, Sánchez-Palacios M. Massive postoperative cerebral swelling following cranioplasty. Int J Crit Illn Inj Sci 2012; 2 (02) 107-108
• 7 Sugii N, Matsuda M, Sekine T, Matsumura H, Yamamoto T, Matsumura A. Delayed brain edema and swelling following craniectomy for evacuation of an epidural abscess that improved by cranioplasty: case report. J Neurol Surg Rep 2017; 78 (03) e109-e112
• 8 Honeybul S. Sudden death following cranioplasty: a complication of decompressive craniectomy for head injury. Br J Neurosurg 2011; 25 (03) 343-345
• 9 Honeybul S, Damodaran O, Lind CR, Lee G. Malignant cerebral swelling following cranioplasty. J Clin Neurosci 2016; 29: 3-6
• 10 Mangubat E, Sani S. Acute global ischemic stroke after cranioplasty: case report and review of the literature. Neurologist 2015; 19 (05) 135-139
• 11 Hassaneen W, Germanwala A, Tsimpas A. Malignant cerebral edema following cranioplasty. J Clin Neurosci 2016; 25: 130-132
• 12 Chaturvedi J, Botta R, Prabhuraj AR, Shukla D, Bhat DI, Devi BI. Complications of cranioplasty after decompressive craniectomy for traumatic brain injury. Br J Neurosurg 2016; 30 (02) 264-268
• 13 Shen L, Zhou Y, Xu J, Su Z. Malignant cerebral swelling after cranioplasty: case report and literature review. World Neurosurg 2018; 110: 4-10
• 14 Kaneshiro Y, Murata K, Yamauchi S, Urano Y. Fatal cerebral swelling immediately after cranioplasty: a case report. Surg Neurol Int 2017; 8: 156
• 15 Sviri GE. Massive cerebral swelling immediately after cranioplasty, a fatal and unpredictable complication: report of 4 cases. J Neurosurg 2015; 123 (05) 1188-1193
• 16 Lee GS, Park SQ, Kim R, Cho SJ. Unexpected severe cerebral edema after cranioplasty: case report and literature review. J Korean Neurosurg Soc 2015; 58 (01) 76-78
• 17 Nomura M, Ota T, Ishizawa M, Yoshida S, Hara T. Intracranial hypotension-associated cerebral swelling following cranioplasty: report of two cases. Asian J Neurosurg 2017; 12 (04) 794-796
• 18 Wang H, Li W, Zhou L, Fu S, Chen B, Zhang S. Malignant cerebral swelling after cranioplasty due to ipsilateral intracranial vasculopathy: case report and literature review. World Neurosurg 2017; 107: 1044.e11-1044.e17
• 19 Kato A, Morishima H, Nagashima G. Unexpected complications immediately after cranioplasty. Acute Med Surg 2017; 4 (03) 316-321
• 20 Moon HS, Lee SK, Kim SR, Kim SJ. Cardiac arrest due to intracranial hypotension following pseudohypoxic brain swelling induced by negative suction drainage in a cranioplasty patient: a case report. Korean J Anesthesiol 2016; 69 (03) 292-295
• 21 Dunn LT. Raised intracranial pressure. J Neurol Neurosurg Psychiatry 2002; 73 (Suppl. 01) i23-i27
• 22 Daboussi A, Minville V, Leclerc-Foucras S. , et al. Cerebral hemodynamic changes in severe head injury patients undergoing decompressive craniectomy. J Neurosurg Anesthesiol 2009; 21 (04) 339-345
• 23 Schuss P, Vatter H, Marquardt G. , et al. Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J Neurotrauma 2012; 29 (06) 1090-1095
• 24 Quah BL, Low HL, Wilson MH. , et al. Is there an optimal time for performing cranioplasties? Results from a prospective multinational study. World Neurosurg 2016; 94: 13-17
• 25 Archavlis E, Carvi Y Nievas M. The impact of timing of cranioplasty in patients with large cranial defects after decompressive hemicraniectomy. Acta Neurochir (Wien) 2012; 154 (06) 1055-1062
• 26 Piedra MP, Nemecek AN, Ragel BT. Timing of cranioplasty after decompressive craniectomy for trauma. Surg Neurol Int 2014; 5: 25
• 27 Finger T, Prinz V, Schreck E. , et al. Impact of timing of cranioplasty on hydrocephalus after decompressive hemicraniectomy in malignant middle cerebral artery infarction. Clin Neurol Neurosurg 2017; 153: 27-34
• 28 Wolff A, Santiago GF, Belzberg M. , et al. Adult cranioplasty reconstruction with customized cranial implants: preferred technique, timing, and biomaterials. J Craniofac Surg 2018; 29 (04) 887-894