Department of Plastic Surgery & Burns, Rabin Medical Center, affiliated with the Tel Aviv University School of Medicine.
Azrieli Faculty of Medicine, Bar-Ilan University, Safed.
J Craniofac Surg. 2022;33(2):e176-e179. doi: 10.1097/SCS.0000000000008240.
Cranioplasty is commonly performed to treat craniosynostosis. A rare postsurgical complication is massive brain swelling with elevated intracranial pressure. This commonly presents with mydriasis, coma, and seizures; radiologic findings include cerebral edema, parenchymal hemorrhages, and ischemic changes.The authors describe a 9-year-old boy who developed massive brain swelling following reduction cranioplasty for secondary turricephaly. His history included surgical repair of metopic-craniosynostosis at age 5.5 months, by means of an anterior cranial-vault reconstruction with fronto-orbital advancement. After presenting to our clinic with a significant turricephalic skull deformity, he underwent cranial reduction cranioplasty. On postoperative day 1, mild neurological signs associated to increased intracranial pressure were noticed. As they worsened and massive brain swelling was identified, he was treated pharmacologically. On postoperative day 13, the patient was operated for decompression.A literature review yielded 4 articles related to massive brain swelling for post-traumatic craniectomies. None described elevated intracranial pressure or massive brain swelling following cranial reduction for secondary craniosynostosis. The main dilemma regarding our patient was the necessity and timing of a second operation.The literature did not reveal relevant recommendations regarding treatment timing nor preventative measures.The authors recommend presurgical neuro-ophthalmological and imaging evaluation, for comparisons and management during the immediate and short-term follow-ups. The authors suggest that for a patient presenting with signs and symptoms of cerebral edema or high intracranial pressure following reduction-cranioplasty, pharmacological treatment should be initiated promptly, and careful drainage and eventual surgical-treatment should be considered if no improvement is shown in the subsequent days.
颅骨修补术通常用于治疗颅缝早闭。一种罕见的术后并发症是颅内压升高导致的大量脑肿胀。这种情况通常表现为瞳孔散大、昏迷和癫痫发作；影像学表现包括脑水肿、脑实质出血和缺血性改变。作者描述了一名 9 岁男孩，在因继发性尖头畸形行颅骨缩小修补术后发生大量脑肿胀。他的病史包括 5.5 个月时因额缝-颅缝早闭而行的前颅底重建和额眶前移手术。因明显的尖头畸形颅骨畸形就诊于我院后，他接受了颅骨缩小修补术。术后第 1 天，出现轻度与颅内压升高相关的神经症状。随着症状恶化和大量脑肿胀的出现，他接受了药物治疗。术后第 13 天，患者因减压而行手术。文献复习发现 4 篇与创伤性颅骨切除术相关的大量脑肿胀的文章。均未描述继发于颅缝早闭的颅骨缩小术后颅内压升高或大量脑肿胀。关于该患者的主要难题是第二次手术的必要性和时机。文献没有提供关于治疗时机或预防措施的相关建议。作者建议在术前进行神经眼科和影像学评估，以便在即时和短期随访期间进行比较和管理。作者建议对于在颅骨缩小修补术后出现脑水肿或高颅内压迹象和症状的患者，应立即开始药物治疗，如果在随后几天内没有改善，应考虑谨慎引流和最终手术治疗。
