A Case of Brain Edema Immediately after Cranioplasty

Abstract

  We report a case of brain edema immediately after cranioplasty. A 57-year-old woman underwent surgical clipping for subarachnoid hemorrhage and decompressive craniectomy. She had cranioplasty on the 83rd hospital day.

  Although the surgery was completed uneventfully, CT of the head showed brainstem edema immediately after the cranioplasty. The brainstem edema developed into cerebral and cerebellar edema, and ultimately brain death. We considered that a bone defect and midline shift may have caused asymptomatic sinking skin flap syndrome (SSFS). We considered further that the cause of the brain edema could have been deterioration of autoregulation, reperfusion, negative pressure by subgaleal drain, venous stasis, or SSFS. The fatality rate due to brain edema that occurs immediately after cranioplasty is high. Cranioplasty is a relatively simple surgery ; however, complications include seizure, infection, and epidural hematoma. It should also be kept in mind that brain edema may occur, and these complications must be explained to the families as an informed consent before surgery.