Complication of a large cranial defect. Case report.

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Acute subdural hematoma (ASH) is a severe traumatic brain injury often requiring surgical decompression.
• Hemicraniectomy is a life-saving procedure for managing increased intracranial pressure in ASH.
• Post-craniotomy complications can impact neurological recovery.

Observation:

• A patient treated with hemicraniectomy for ASH developed contralateral weakness four months post-surgery.
• The neurological deficit was transient and fully reversed following cranioplasty.
• This suggests a potential link between cranial defect and neurological function.

Findings:

• The observed contralateral weakness is hypothesized to result from a pressure gradient between the atmosphere and the intracranial compartment through the cranial defect.
• Cranioplasty restored normal intracranial pressure dynamics, resolving the weakness.
• This case highlights a specific, reversible neurological complication post-hemicraniectomy.

Implications:

• Early consideration of cranioplasty may be warranted to prevent delayed neurological deficits related to atmospheric pressure gradients.
• Understanding the pathophysiology of post-craniotomy syndrome is crucial for optimizing patient outcomes.
• This case contributes to the literature on the management and potential complications of hemicraniectomy for traumatic brain injury.