External Brain Herniation 4 Months after Decompressive Hemicraniectomy

Decompressive hemicraniectomy (DH) is a life-saving surgery, performed in cases of severe mass effect due to stroke (ischemic or hemorrhagic) or head trauma. The skull bone overlying the affected cerebral hemisphere is removed (and stored in a “bone bank”).

Decompressive hemicraniectomy is generally safe, however, it could be associated with complications in a few cases. Recently, we noticed one of the commonly seen complications. A 50-year man presented with soft swelling over the right fronto-parieto-temporal regions. This patient had undergone decompressive hemicraniectomy four months earlier for malignant right middle cerebral territory infarction.

CT brain showed external brain herniation (yellow arrows). In a few sections, we can also see septations (red arrows).

This condition can be easily treated with a surgery called cranioplasty, where the bone (stored in the hospital) is replaced to its original place in the skull.

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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