Massive XXXX immediately after cranioplasty, a fatal and unpredictable complication: report of 4 cases.

@entity1 @entity131 @entity4282 @entity2657 @entity944 @entity4
UNASSIGNED: Cranioplasty after decompressive craniectomy (DC) is associated with increased morbidity, but the reported mortality rate is low. Recently, some authors have reported a rare unexplained complication of @entity944 in association with massive @entity2657 immediately after cranioplasty. The author reports on 4 @entity1 who underwent cranioplasty after DC between January 2005 and August 2010 at his department and died because of massive @entity2657 immediately after uneventful surgery and anesthesia. All 4 of the new cases reported involved young male @entity1 who underwent decompressive hemicraniectomy after @entity131 . They developed massive @entity4 immediately after uneventful cranioplasty (3 @entity1 ) or after removal of an @entity4282 several hours after surgery (1 @entity1 ). All 4 @entity1 had a large skull defect and significantly sunken craniotomy site, and all were treated with a closed vacuum suction system that was placed under the scalp and kept open at the end of the cranioplasty procedure. After surgery, the @entity1 ' pupils became fixed and dilated, and brain CT scans showed massive @entity2657 . Despite emergency DC, the @entity1 did not recover, and all 4 died. A MEDLINE search showed 8 similar cases that were reported previously. Fatal @entity4 after uneventful cranioplasty is a distinct clinical entity, although it is unpredictable. It is postulated that a negative pressure difference from the elimination of atmospheric pressure that had been chronically applied on the injured sinking brain in combination with the negative pressure applied by the closed subgaleal suction drain may lead to a massive brain shift toward the cranioplasty site and initiate a fatal vasomotor reaction.
