ACUTE BRAIN-SWELLING DURING REMOVAL OF SUPRATENTORIAL CYSTIC LESION CAUSED BY CONTRALATERAL EXTRADURAL HEMATOMA - CASE-REPORT

BACKGROUND Protrusion of the cortex through a bone flap in the course of surgery is a very serious event and, if it persists, the procedure must be suspended, the cause sought, and the problem resolved. CASE DE SCRIPTION We report the case of a 13-year-old boy whose brain underwen t sudden swelling during removal of a supratentorial cystic lesion. Th e operation was suspended at once and an emergency CT scan was perform ed. It revealed a large contralateral extradural hematoma, which was r emoved immediately. CONCLUSIONS We considered the following possible m echanisms of the emergency: bleeding of bone at the site of the suppos ed piercing by the headrest pin and/or a vacuum mechanism consequent u pon removal of the large cystic lesion. Our aims are to emphasize the importance of gauging the thickness of a child's skull before fixing t he head in the headrest, especially when chronic intracranial hyperten sion is present, and the need to suspend the operation for CT scanning in the event of uncontrollable brain swelling. (C) 1997 by Elsevier S cience Inc.