One case report of delayed severe intracerebral and intraventricular hemorrhage after cranioplasty.

BACKGROUND: Cranioplasty is a relatively simple neurosurgical procedure, and common complications of cranioplasty include dural tears, CSF leakage, infection, epilepsy, epidural hematoma and bone flap resorption. Intracerebral hemorrhage as a complication of cranioplasty is rare, and it is often fatal. The report describes one case of delayed severe intracerebral and intraventricular hemorrhage after an uneventful cranioplasty.

CASE PRESENTATION: A previously healthy 29-year-old man was admitted to our hospital with a traumatic left frontotemporoparietal acute subdural hematoma, an emergency decompressive craniectomy with clot removal was performed. Four months after the surgery, cranioplasty was performed with a titanium mesh, the surgery was uneventful. Six hours after the operation, a CT scan demonstrated no bleeding or edema. In the following 2 days after cranioplasty, the patient did not have any neurological deficits, normal blood pressure was recorded every day, no trauma occurred, and routine laboratory test results were within normal limits. However, on the third day after cranioplasty, the patient suffered a sudden severe headache while playing games on his mobile phone, and then rapidly fell into deep coma; both pupils were fixed and dilated at 5 mm with no response to light. An immediate CT scan revealed a massive intracerebral hematoma and intraventricular hematoma on the left side, and the midline shifted to the right side. Therefore, an ipsilateral decompressive craniectomy was performed with evacuation of the hematoma; the obvious bleeding point was not identified, and no obvious vascular abnormalities were found during the operation. A CT scan on day 3 after reoperation revealed successful decompression, and CT angiography showed no vascular abnormalities. Despite all treatment measures, the patient did not regain consciousness, his neurological situation did not improve after the operation, and the patient lived in a vegetative state.

CONCLUSION: Although intracerebral and intraventricular hemorrhage after cranioplasty is extremely rare, it is often fatal. Aside from hyperperfusion and cerebral autoregulation dysfunction, traction injuries to the fragile vessels due to posttraumatic angiogenesis may also be one of the key factors of complications after cranioplasty.