PMC9282772_01
Intracranial Hemorrhage. (a and b) Preoperative enhanced CT scan of the head demonstrating a large intraparenchymal hemorrhage with significant mass effect and secondary midline shift to the left. No extravasation after contrast administration was noticed. (c) Preoperative scalp marking (d) brain exposure. A small corticectomy in the most basal aspect of the brain exposure is demonstrated. (e) The drained clot counted for approximately 5 cm3 volume is observed. (f) Postoperative picture of the inverted T-bar incision without evidence of dehiscence. (g and h) 1-year follow-up postoperative post contrast axial and sagittal T1 images.
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F2
The nonenhanced CT scan demonstrated a right temporoparietal ICH with significant mass effect and midline shift to the left [Figure 2].
PMC9282772_02
Subdural empyema. (a-c) Non-enhanced CT scan demonstrates a recurrent subdural empyema with separate extension to the right frontal and parietal lobes. (d-e) Intraoperative images show the purulent collection drainage, remarkable brain edema, and epidural bleeding. (f) A postoperative picture of the T-bar incision is demonstrated. (g-i) One-year follow-up enhanced MRI of the head shows no recurrent empyema. (g-h) One-year postoperative MRI with gadolinium administration showed encephalomalacia with the recovery of the normal position of the frontal and temporal lobes.
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F3
A recurrent right 8.4 mm frontoparietal subdural empyema with a 4 mm midline shift to the left was detected in the postoperative nonenhanced CT scan [Figure 3].
PMC9282772_03
L.G. Kempe's incision for trauma. (a and b) A preoperative CT scan demonstrates a left acute subdural hematoma with mass effect and a midline shift to the right with effacement of the basal cisterns. (c-f) An inverted "T-bar" incision is demonstrated, with consequent drainage of the hematoma and duroplasty. (g-h) Postoperative CT scan shows complete drainage of the hematoma, recovery of the midline, and the cranial defect in the left parietotemporal cranial vault.
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F4
The CT scan revealed a left acute subdural hematoma with a midline shift to the right and effacement of the basal cisterns [Figure 4].
PMC9282772_04
Decompressive craniectomy for ischemic stroke. (a) Admission-enhanced CT scan of the head demonstrates a large left middle cerebral artery infarction. (b) Two-hour admission nonenhanced CT scan shows hemorrhagic transformation of the stroke with significant edema and midline shift to the right. (c) Postoperative CT scan demonstrates recovery of the midline and transcranial herniation of the infarcted parenchyma. (d) Skin marking with a T-shaped Kempe's mark. (e) Bone exposure. In this picture, the inferior displacement of the temporal muscle allows adequate exposure of the cranium. (f) After opening the dura mater, significant edema was evident.
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F5
CT scan showed a large left middle cerebral artery ischemic stroke [Figure 5]. Consequently, the patient underwent a left DC through an LGK incision and a right-sided EVD placement.