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Updated: Apr 20, 2026

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
[Paradoxical transtentorial herniation, extreme trephined syndrome sign: A case report]
Jose Maria Narro-Donate1, Antonio Huete-Allut1, Jose A Escribano-Mesa1
1Departamento de Neurocirugía, Complejo Hospitalario Torrecárdenas, Almería, España.
Abstract:
The current increasing use of decompressive craniectomy carries the implicit appearance of complications due to alterations in both intracranial pressure and in the hydrostatic-hemodynamic equilibrium. Paradoxical transtentorial herniation represents a rare manifestation, included in "trephine syndrome", extremely critical but with relatively simple treatment. We present the case of a 56-year-old woman with no interesting medical history, who, after an olfactory groove meningioma surgery, presented a haemorrhage located in the surgical area with an important oedema. The patient required a second emergency surgery without any chance of conserving the cranial vault. During the post-operational period, great neurological deterioration in orthostatic position was noticed, which resolved spontaneously in decubitus. This deficit was resolved with bone replacement afterwards. We discuss possible predisposing factors and aetiologies of this pathology.
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