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A Craniotomy Surgery Procedure for Chronic Brain Imaging
Published on: February 15, 2008
Managing the "big black brain" in low resource setting: A case report of early outcome after hinge craniotomy
Andre Marolop Pangihutan Siahaan1, Bahagia Willibrordus Maria Nainggolan2, Martin Susanto2
1Department of Neurosurgery, Universitas Sumatera Utara, Medan, North Sumatera, Indonesia.
Insights
The big black brain (BBB) phenomenon in infants, a response to acute subdural hematoma (SDH), can be successfully treated with emergency hinge craniotomy, leading to rapid recovery.
Area of Science:
- Pediatric Neurosurgery
- Neuroradiology
- Critical Care Medicine
Background:
- The big black brain (BBB) phenomenon, characterized by diffuse supratentorial hypodensity and swelling, is a critical response to acute subdural hematoma (SDH) in infants.
- Management of BBB remains challenging due to high associated morbidity and mortality.
- This report details a case of BBB in a 2-month-old infant presenting with neurological decline.
Observation:
- A 2-month-old infant presented with decreased consciousness, seizures, and cardiopulmonary arrest, with no history of trauma.
- Computed tomography revealed subacute SDH with bilateral hemispheric hypodensity.
- Emergency hinge craniotomy was performed to evacuate the hematoma on the affected side.
Findings:
- The infant demonstrated rapid clinical improvement, crying spontaneously within 24 hours post-procedure.
- The patient was discharged six days after the emergency surgery.
- Early outcomes suggest hinge craniotomy is a viable emergency treatment for BBB.
Implications:
- Hinge craniotomy offers a potentially life-saving intervention for infants with BBB.
- Long-term neurodevelopmental outcomes following this intervention require continued monitoring.
- Further research is needed to establish optimal management strategies for BBB.
Background:
The big black brain (BBB) phenomenon is described as an infant's response to an acute subdural hematoma (SDH). It is characterized by hypodensity and swelling of the supratentorial compartment as a whole. Numerous factors may contribute to the formation of the BBB. Due to its high morbidity and mortality, the management of BBB is still debatable. In this report, we describe a 2-month-old boy who had bilateral hemispheric hypodensity and underwent hinge craniotomy.
Case Description:
The patient was referred to our hospital with decreased consciousness. The patient had a history of seizures and cardiopulmonary arrest. There is no history of trauma. The computed tomography revealed a subacute SDH on the left parietal and occipital lobe along with hypodensity in both hemispheres with preservation of posterior fossa, consistent with hemispheric hypodensity. We performed a hinge craniotomy for the emergency procedure and evacuated only the hemisphere with the bleeding side. The patient cried spontaneously 24 hours after the procedure and was discharged six days later.
Conclusion:
Early outcomes of hinge craniotomy as an alternative procedure for treating the BBB were positive. However, long-term outcomes, particularly the infant's development, should be monitored.
