External brain tamponade: a rare complication of decompressive craniectomy
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Decompressive craniectomy implies removal of a portion of the skull to decompress the intracranial contents. This neurosurgical procedure has an established and important role in neurocritical care. The common indications are traumatic brain injury, refractory malignant intracranial hypertension, subarachnoid haemorrhage and malignant middle cerebral artery infarction [1, 2, 3]. The cranioectomy procedure can be bilateral in cases of diffuse brain oedema without midline shift, or unilateral in patients with one sided brain swelling with midline shift . Since the operation involves removal of a large piece of skull, it leads to alteration of the cranial pathophysiology, and can also result in a variety of complications like external brain tamponade, trephine syndrome, extra cranial herniations, cerebral contusions, infections, subgaleal or subdural hygromas [2, 4]. External brain tamponade is one of the uncommon, but serious complications, which is characterized by a tense crainectomy flap, neurological decline, subgaleal fluid collection with mass effect on underlying brain, and neurological improvement after drainage [2, 4]. The underlying cause is tense accumulation of fluid in the subgaleal space due to a ball valve type effect or pressure gradient . The CT scan is the imaging modality of choice for evaluation of the post crainectomy complications because of its high speed, relatively low cost and widespread availability. On the CT scan, external brain tamponade is visualized as a fluid attenuation collection in the subgaleal space with bulging of the skin flap, and compression of underlying brain parenchyma . All these findings were present in our case.
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Conflict of interest
The authors declare that they have no conflict of interest.
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All procedures performed in this study involving human participant are in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from parents of patient for voluntary participation in the study.