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
