Symptomatic ptosis cerebelli after suboccipital craniectomy in a patient with severe brain trauma

Primary objective: To report the first case of symptomatic cerebellar ptosis after a large suboccipital craniectomy in a patient with severe brain trauma and a review of the literature. Patient and methods: A 36-year-old man suffered severe traumatic brain injury after a four-metre fall. He underwen...

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Bibliographic Details
Published in:Brain injury 2017-08, Vol.31 (10), p.1294-1297
Main Authors: Castaño-Leon, Ana M., Cepeda, Santiago, Paredes, Igor, Gómez, Pedro A., Jiménez-Roldán, Luis, Lagares, Alfonso, Pérez-Núñez, Angel
Format: Article
Language:English
Subjects:
Adult
Brain Injuries - diagnostic imaging
Brain Injuries - surgery
brain trauma
Cerebellar Diseases - diagnostic imaging
Cerebellar Diseases - etiology
Cerebellar Diseases - surgery
craniectomy
cranioplasty
Craniotomy - adverse effects
Humans
Hydrocephalus - etiology
Hydrocephalus - surgery
Magnetic Resonance Imaging
Male
Postoperative Complications - diagnostic imaging
Postoperative Complications - etiology
Ptosis cerebelli
Reconstructive Surgical Procedures
Skull - surgery
Treatment Outcome
Ventriculoperitoneal Shunt
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Summary:Primary objective: To report the first case of symptomatic cerebellar ptosis after a large suboccipital craniectomy in a patient with severe brain trauma and a review of the literature. Patient and methods: A 36-year-old man suffered severe traumatic brain injury after a four-metre fall. He underwent a large suboccipital craniectomy because his computed tomography scan revealed a posterior fossa subdural haematoma and cerebellar swelling. Four weeks after admission, he developed communicating hydrocephalus, and a ventriculoperitoneal shunt was placed. Although he experienced good recovery, seven months after the trauma he complained of cephalea, dizziness, recurrent vomiting and diplopia. Magnetic resonance imaging (MRI) showed descent of the cerebellum through a wide bone defect. Results: We performed a posterior fossa cranioplasty after other causes of delayed worsening were ruled out, such as shunt malfunction, overdrainage and ischaemic lesions. The patient improved, and a post-operative MRI confirmed the upward migration of the cerebellum. Conclusions: Cerebellar ptosis must be considered in cases of delayed symptoms after large suboccipital craniectomy regardless of pathology. Posterior fossa cranioplasty to provide structural support to slumped cerebellum can improve or resolve symptoms.
ISSN:0269-9052
1362-301X
DOI:10.1080/02699052.2017.1309571