In situ free-floating craniectomy: an unusual cause of chronic post-traumatic cephalalgia.
We describe a case of post-traumatic cephalalgia in a 54-year-old man with chronic right parieto-occipital headache 3 years posthead injury. At the initial presentation, his Glasgow Coma Scale (GCS) was 13/15 and CT brain revealed an acute subdural haematoma with fronto-temporal contusions. After 24 h his GCS dropped to 8/15 and subsequently he underwent a right-sided craniotomy and evacuation of the subdural haematoma and contusionectomy and intracranial pressure monitoring. To manage the cerebral oedema, the cranial bone flap was left in situ free-floating and was managed in an intensive care setting. He made good clinical recovery and 3 months postoperatively he complained of right-sided headache not relieved with medication and occipital nerve block. Three years later he underwent an exploration of the previous craniotomy scalp wound and the free-floating bone flap under the scalp was immobilised. The headache completely resolved following the procedure and is currently asymptomatic.
Department of Neurosurgery, Cork University Hospital, Wilton, Cork, Republic of Ireland. ckaliaperumal@gmail.com
Chandrasekaran
C
Kaliaperumal
Savitha
S
Raveendran
D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods; D006261:Headache / Q000209:etiology* / Q000601:surgery; D020199:Hematoma, Subdural, Acute / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography