Intracranial Hypotension and Hypertension Associated With Reconstructive Cranioplasty After Decompressive Craniectomy: Report of a Lethal Complication With Recommended Strategies for Future Avoidance

Reconstructive cranioplasty can be associated with many complications and add to the not insignificant potential risks associated with decompressive craniectomy. In the setting of post-traumatic hydrocephalus, treatment with a ventriculoperitoneal (VP) shunt prior to reconstructive cranioplasty likely increases these risks even further. The authors report a case of a 17-year-old male with a history of a severe closed head injury who initially suffered a life-threatening complication associated with intracranial hypotension after cranioplasty only to succumb to malignant intracranial hypertension following a second cranioplasty attempt. To our knowledge, this is the first description of a single patient developing both these disparate complications after reconstructive cranioplasty and emphasizes the likely synergistic hazards involved with decompressive craniectomy in the setting of a VP shunt in particular and the overall myriad potential complications that may be associated with reconstructive cranioplasty in general. Address correspondence and reprint requests to Hal S. Meltzer, MD, FAANS, 7910 Frost Street, Suite 120, San Diego, CA 92123; E-mail: hsmeltzer@ucsd.edu Received 31 July, 2017 Accepted 10 May, 2018 Previously presented in part at: 39th Annual Meeting of the American Society of Pediatric Neurosurgeons, February 5, 2016, Aruba. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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