Cranioplasty is a comparatively basic neurosurgical procedure, and fatal complications are

Cranioplasty is a comparatively basic neurosurgical procedure, and fatal complications are rare. occurred.[1] Here, we report two rare cases of cerebral swelling and subsequent death following otherwise uneventful cranioplasty and discuss the possible pathophysiology underlying this phenomenon. Case Reports A total of 299 cranioplasties were performed in Tokyo Metropolitan Tama INFIRMARY between 2000 and 2013. Of the cases, 2 individuals (0.67%) had comparable courses leading to death. Case 1 A 43-year-old man was admitted to your medical center with subarachnoid hemorrhage (SAH) because of a ruptured middle cerebral artery (MCA) bifurcation aneurysm. The individual underwent decompressive craniectomy where the aneurysm was clipped and related regular arteries had been preserved. A postoperative computed tomography (CT) scan showed mind swelling. As the mind edema worsened, lobectomy and duraplasty with artificial dura mater had been performed. On day time 46 following the first procedure, he underwent cranioplasty with an autologous bone flap. Before cranioplasty, all bloodstream tests Rabbit Polyclonal to ALK were regular, and a mind CT scan exposed subcutaneous cerebrospinal liquid (CSF) [Figure ?[Shape1a1a and ?andb].b]. As your skin was incised, a lot of CSF premiered. The task uneventfully finished with keeping a subgaleal drain. Immediately after surgical treatment, we noticed a great deal of bloody CSF in the shut vacuum drainage program. A postoperative CT scan demonstrated substantial cerebral swelling [Shape ?[Shape1c1c and ?andd].d]. Angiography demonstrated a marked delay of cerebral circulation. The individual died within 72 h. Anoxia during anesthesia was excluded by the operative chart. Although the deep venous program had not been evaluated, the autopsy purchase PRI-724 exposed no proof vessel occlusion. Open up in another window Figure 1 Computed tomography scans in the event 1 (a and b) preoperative axial computed tomography scan displaying distinct subcutaneous liquid collection and subdural space. (c and d) Postoperative axial computed tomography scan displaying whole mind swelling and midline change Case 2 A 73-year-old guy offered SAH with remaining temporal lobe hematoma, and angiography demonstrated a remaining MCA aneurysm. The individual underwent decompressive craniectomy and definitive aneurysm clipping. Two times later, mind swelling created, and thus growth of the craniectomy and lobectomy was performed. During surgical treatment, the lateral ventricle was opened up and filled with purchase PRI-724 gelatin sponge. Artificial dura mater was utilized for dural closure. On day time 41 following the first surgical treatment, cranioplasty purchase PRI-724 was performed. The preoperative bloodstream test results had been in the standard range, aside from hook elevation of white bloodstream cellular material and C-reactive proteins [Desk 1]. A CT scan revealed substantial subcutaneous and subdural liquid accumulation [Figure purchase PRI-724 ?[Shape2a2a and ?andb].b]. In the operation, a lot of CSF premiered and the mind was collapsed. A subgaleal tube was positioned and liquid accumulation drained spontaneously. Although the essential signs were steady during anesthesia, the systolic blood purchase PRI-724 circulation pressure elevated to 190 mmHg soon after the finish of the procedure. His pupils became dilated, and a CT scan confirmed substantial cerebral swelling with spotty hemorrhaging in the contralateral basal ganglia [Figure ?[Shape2c2c and ?andd].d]. Angiography revealed slow movement, and the deep venous program was not obviously visualized. Postoperative bloodstream tests revealed improved fibrin degradation items and D-dimer [Desk 1]. The individual died within 24 h. The autopsy exposed thrombus and broken endothelial cellular material in the deep venous sinus, and therefore deep venous sinus thrombosis was diagnosed [Figure ?[Shape3a3a and ?andbb]. Table 1 Blood assessments data of case 1 Open in a separate window Open in a separate window Figure 2 Computed tomography scans in case 2 (a and b) preoperative axial computed tomography scan showing distinct subcutaneous fluid collection and subdural space communication with the ventricle. (c and d) Postoperative axial computed tomography scan showing diffuse brain swelling, midline shift, and scattered petechial hemorrhaging Open in a separate window Figure 3 Autopsy findings in case 2 (a) macroscopic examination.