Case Diagnosis: A 22-year-old male with a complex medical history underwent cranioplasty but experienced a functional plateau, increased pain, and a fluid-filled area in the head, ultimately leading to the diagnosis of brain evagination and transfer to neurosurgery for further management.
Case Description: A 22-year-old male with B-cell acute lymphoblastic leukemia, disseminated intravascular coagulation, and recent right-sided temporal hemicranioplasty following subdural empyema. Due to encephalopathy-related decreased independence, the patient was admitted to an inpatient rehabilitation hospital. Notable improvements in cognition and daily living activities were observed initially. However, the patient subsequently reported worsening pain and a fluid-filled area in the right posterior head region. A CT head scan confirmed the presence of brain evagination.
Discussion: Cranioplasty, a cranial vault reconstruction procedure, carries various complications. Acute complications include contusion expansion, epidural hematoma, external cerebral herniation, intracranial infection, epilepsy, CSF leakage, and wound issues. Early complications within months post-surgery involve subdural effusions, contralateral mass lesion progression, paradoxical herniation, and infection. Delayed complications after 30 days include sinking skin flap syndrome, hydrocephalus, bone resorption, osteomyelitis, and hypo-vascular bone necrosis. Complications are influenced by factors such as age and material selection, emphasizing the significance of careful patient selection, surgical technique, and material choice to mitigate these risks.
Setting: Inpatient Rehabilitation Hospital
Assessment/Results: The patient was transferred from inpatient rehabilitation to neurosurgery for further management.
Conclusion: Close monitoring of cognitive function and activities of daily living during rehabilitation following cranioplasty is crucial in preventing brain evagination. Early identification of functional decline allows for timely intervention, including adjustments to rehabilitation strategies or revision surgery when necessary. Diligent observation reduces the risk of brain evagination and associated deficits. Healthcare professionals should prioritize vigilant monitoring to detect subtle changes indicating complications. This comprehensive approach leads to improved patient outcomes by preserving optimal neurological function.
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