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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(01): 256-261
DOI: 10.4103/ajns.AJNS_285_17
Case Report

The “negative” impact of a subgaleal drain: Post-cranioplasty negative pressure subgaleal drain-induced ascending transtentorial herniation

Peter Woo
Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei
,
Wilson Lo
Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei
,
Hoi-Tung Wong
Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei
,
Kwong-Yau Chan
Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei
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One commonly practiced procedural step to reduce the risk of postoperative hematoma accumulation when performing cranioplasties is to place a closed negative-pressure subgaleal drain. We present a patient with sinking skin flap syndrome that underwent such a procedure and subsequently experienced immediate postoperative ascending transtentorial herniation and intracranial hemorrhage remote from the surgical site. On determining that the subgaleal drain was the responsible cause, it was immediate removed, and the patient had neurological recovery. Fewer than 30 cases of life-threatening subgaleal drain-related complications have been documented, and this is the first reported case of ascending herniation occurring after cranioplasty. This report illustrates the potential risks of subgaleal drainage, the importance of early recognition of this rare phenomenon and that intervention can be potentially life-saving.

Key-words:

Ascending transtentorial herniation - cranioplasty - subgaleal drainage

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Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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