PMC6417323_01
Preoperative computed tomography scan revealing a large sunken craniectomy site with paradoxical herniation (a, b axial; c three-dimensional reconstruction). Immediate postcranioplasty scan showing interhemispheric acute subdural hematoma (white arrow), intraventricular hemorrhage (white arrowhead) and ascending transtentorial herniation with upward displacement of the cerebellar vermis (grey arrow) (d, e, axial; f midsagittal). One-day postoperative scan after subgaleal drain removal showing spontaneous resolution of transtentorial herniation (g, axial; h, midsagittal)
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F1
There was a large right fronto-parietal-temporal scalp concavity coinciding with a craniectomy skull defect of 25 cm x 20 cm [Figure 1a-c]. There was also upward displacement of the vermis at the level of the incisura and flattening of the posterior third ventricle [Figure 1d-f]. She was sedated for 24 hours and a CT brain performed the next day showed resolution of the ATH [Figure 1g, h].