Turkish Neurosurgery
Paradoxical Herniation after Unilateral Decompressive Craniotomy: a retrospective analysis of clinical characteristics and effectiveness of therapeutic measures
Huangyi JI1, Weiqiang CHEN1, Xiaohuan YANG2, Jingfang GUO1, Jin WU1, Mindong HUANG3, Chuwei CAI4, Yingming YANG1
1Shantou University Medical College, First Affiliated Hospital, Department of Neurosurgery, Shantou, Guangdong,
2Shantou University Medical College, First Affiliated Hospital, Department of Science and Education, Shantou, Guangdong,
3The People?s Hospital of Jieyang City, Department of Neurosurgery, Jieyang, Guangdong,
4The Central Hospital of Shantou City, Department of Neurosurgery, Shantou, Guangdong,
DOI: 10.5137/1019-5149.JTN.15643-15.1
Aim:We aimed to investigate the importance of early diagnosis and proper management of paradoxical herniation based on the data of 13 patients who had 14 occurrences of paradoxical herniation.Material and Methods:The characteristics and the effectiveness of treatments of 13 patients with paradoxical herniation were reviewed and analyzed retrospectively. Results:Paradoxical herniation occurred in eight patients (61.54%) during the post-operative 2 weeks presented typical symptoms of brain herniation and a tense skin flap without sinking at the region of decompressive craniotomy. On the other hand, six patients developed paradoxical herniation in the post-operative period of 2 weeks to 2 months and presented sinking skin flaps and delayed neurological deficits. Furthermore, all patients received emergency treatments, including sufficient hydration, clamping cerebral spinal fluid (CSF) drainage, and being placed in the Trendelenburg position. Six patients achieved full neurologic recovery after successful cranioplasty. Conclusion:Intracranial hypotension causing paradoxical herniation can rapidly progressed especially along with CSF depletion. It is important for neurosurgeons to suspect paradoxical herniation in a subset of patients with large craniotomy defects and tense skin flap without sinking during the post-operative 2 weeks. Paradoxical herniation is rapidly reverted by improving CSF hydration, and performing early cranioplasty referred as the definitive treatment.
Corresponding author : Weiqiang CHEN