Post craniectomy paradoxical brain herniation: a case report with radiological review

Sinking skin flap (SSF) syndrome and paradoxical brain herniation are rare complications after craniectomy. On CT scan, there is shrunken appearance of the skin flap at craniectomy site. The meningogaleal complex is drawn inwards and is resting on underlying deformed brain with resultant concave surface. It results due to altered CSF hydrodynamics. Paradoxical brain herniation is rare complications which occur in patients who undergo cerebrospinal fluid (CSF) drainage procedures like lumbar puncture (LP), external ventricular drainage, ventriculo-peritoneal shunting and post craniectomy. Its early detection on imaging is essential as it is a neurosurgical emergency. We report a case of 75 year old male previously operated for left chronic subdural hematoma in the left fronto-temporo-parietal region presenting with altered consciousness and inability to walk. Plain CT scan showed craniectomy defect in the left fronto-temporo-parietal region with indrawing of meningogaleal complex suggestive of Shrunken Skin Flap. There was mass effect on the left lateral ventricle and third ventricle with shift of the midline structures towards right (1cm) with evidence of subfalcine herniation suggestive of paradoxical brain herniation

Post craniectomy paradoxical brain herniation: a case report with radiological review

Sinking skin flap (SSF) syndrome and paradoxical brain herniation are rare complications after craniectomy. On CT scan, there is shrunken appearance of the skin flap at craniectomy site. The meningogaleal complex is drawn inwards and is resting on underlying deformed brain with resultant concave surface. It results due to altered CSF hydrodynamics. Paradoxical brain herniation is rare complications which occur in patients who undergo cerebrospinal fluid (CSF) drainage procedures like lumbar puncture (LP), external ventricular drainage, ventriculo-peritoneal shunting and post craniectomy. Its early detection on imaging is essential as it is a neurosurgical emergency. We report a case of 75 year old male previously operated for left chronic subdural hematoma in the left fronto-temporo-parietal region presenting with altered consciousness and inability to walk. Plain CT scan showed craniectomy defect in the left fronto-temporo-parietal region with indrawing of meningogaleal complex suggestive of Shrunken Skin Flap. There was mass effect on the left lateral ventricle and third ventricle with shift of the midline structures towards right (1cm) with evidence of subfalcine herniation suggestive of paradoxical brain herniation

Intraosseous lipoma of the calcaneum

Calcaneal Intraosseous lipoma is a very rare lesion usually benign tumor, which constitutes not more than 2% of bone tumors. On plain radiographs, an intraosseous lipoma is usually seen as benign-appearing osteolytic bone lesion with well-defined margins and calcified/ossified dense matrix. Plain radiographs alone cannot establish the diagnosis of intraosseous lipoma as it imitates several other benign and malignant bone lesions. Intraosseous lipoma contains calcified necrotic fat with mature adipose tissue and characteristically induces expansion/remodeling of the affected bone