Transtentorial Brain Herniation After Lumbar Drainage in Patient Planned for Cranioplastic Reconstruction: Catastrophic Play Between Atmospheric and Intracranial Pressure.

Abstract

The sinking skin flap syndrome, also known as the syndrome of the trephined or the trephination syndrome, occurs in patients who have undergone a decompressive craniectomy. As opposed to this, persistent brain herniation also occurs in patients after a decompressive craniectomy and a cerebrospinal fluid (CSF) drainage procedure is one of the therapies used to reduce it. A continuous lumbar CSF drainage procedure can upset the pressure dynamics of the atmosphere versus intracranial pressures to a point of fatal clinical deterioration and hence needs to be closely monitored. Our case report speaks of persistent brain herniation in which drainage of CSF led to a trephination syndrome, which was reversed once again, by measures to increase CSF production and intracranial pressure. Timely intervention eventually led to a favorable outcome and avoidance of a catastrophy.