{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:56:26Z","timestamp":1787025386372,"version":"build-2736575974"},"reference-count":30,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Several changes in normal pressure dynamics on the brain occur with a decompressive craniectomy and subsequent cranioplasty. Dead space volume is an important factor contributing to intracranial volume postcranioplasty. A decrease in this volume due to negative suction drain along with relative negative pressure on the brain with the loss of external atmospheric pressure may lead to fatal cerebral edema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Case Description:<\/jats:title>\n                    <jats:p>A 52-year-old gentleman with a 210 mL volume and middle cerebral artery territory infarction underwent an emergency craniectomy and 6 months later a titanium mold cranioplasty. Precranioplasty computed tomography (CT) scan evaluation revealed a sunken skin flap with a 9 mm contralateral midline shift. Immediately following an uneventful surgery, the patient had sudden fall in blood pressure to 60\/40 mmHg and over a few min had dilated fixed pupils. CT revealed severe diffuse cerebral edema in bilateral hemispheres with microhemorrhages and expansion of the sunken right gliotic brain along with ipsilateral ventricular dilatation. Despite undergoing a contralateral decompressive craniectomy due to the midline shift toward the right, the outcome was fatal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Careful preoperative risk assessment in cranioplasty and close monitoring postprocedure is crucial, especially in malnourished, poststroke cases, with a sinking skin flap syndrome, and a long interval between decompressive craniectomy and cranioplasty. Elective preventive measures and a low threshold for CT scanning and removal of the bone flap or titanium mold are recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/sni_391_2023","type":"journal-article","created":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T05:41:18Z","timestamp":1691127678000},"page":"271","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Malignant bihemispheric cerebral edema after cranioplasty \u2013 An extension of the Monro-Kellie doctrine and predictive factors"],"prefix":"10.25259","volume":"14","author":[{"given":"Mrudul Mohinish","family":"Bhatjiwale","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Mariswamappa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chinmaya Mission Hospital, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Komal Prasad","family":"Chandrachari","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Narayana Health Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohinish","family":"Bhatjiwale","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neuro Health Foundation Clinic, Borivali West, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanvi","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Apollo Hospitals, Chennai, Tamil Nadu, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thimappa","family":"Hegde","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Narayana Health Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshay Vijay","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Narayana Health Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2023,8,4]]},"reference":[{"key":"10.25259\/SNI_391_2023\/ref-1","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1056\/NEJM194809302391401","article-title":"Chronic subdural hematoma; expansion of compressed cerebral hemisphere and relief of hypotension by spinal injection of physiologic saline solution","volume":"239","author":"Aa","year":"1948","journal-title":"N Engl J Med"},{"key":"10.25259\/SNI_391_2023\/ref-2","first-page":"5","article-title":"Cranioplasty: Routine surgical procedure or risky operation?","volume":"9","author":"Acciarri","year":"2016","journal-title":"World J Surg 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