• Liang Shen, Yue Zhou, Jie Xu, and Zhongzhou Su.
• Department of Neurosurgery, Huzhou Central Hospital, Huzhou, Zhejiang, China.
• World Neurosurg. 2018 Feb 1; 110: 4-10.

BackgroundCranioplasty is considered a low-risk operation in the field of neurosurgery following decompression craniectomy. Well-known complications after cranioplasty, such as infection, seizure, and titanium plate exposure, may not threaten the lives of patients. Unfortunately, there are many fatal complications that are underreported. In this study, we report a case and perform a literature review to introduce malignant cerebral swelling, which is regarded as a devastating complication.Case DescriptionA 51-year-old man who was a victim of traumatic brain injury underwent emergency clot removal and decompression craniectomy. His neurologic condition improved with subsequent rehabilitation therapy, and he had left sinking skin flap syndrome where the skull was defective. Six months after the initial surgery, he underwent a cranioplasty; however, he did not recover from the uneventful anesthesia. A vacuum suction drain showed 300 mL of flow outflow had drained when his pupils dilated and fixed. An immediate computed tomography scan showed ipsilateral diffuse cerebral swelling with diffuse cerebral hemorrhage. Despite all approaches that were considered, the cerebral swelling continued to worsen until death.ConclusionCranioplasty is a high-risk procedure in some cases. Sinking skin flap syndrome and vacuum suction drain may be the main risks of a postoperative venous congestion and stasis, which may result in diffuse cerebral swelling. Once the computed tomography scan shows malignant cerebral swelling, the patient is expected to have a poor prognosis.Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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