title: [Paradoxical transtentorial herniation, extreme trephined syndrome sign: A case report].
abstract: The current increasing use of decompressive craniectomy carries the implicit appearance of complications due to alterations in both intracranial pressure and in the hydrostatic-hemodynamic equilibrium. Paradoxical transtentorial herniation represents a rare manifestation, included in "trephine syndrome", extremely critical but with relatively simple treatment. We present the case of a 56-year-old woman with no interesting medical history, who, after an olfactory groove meningioma surgery, presented a haemorrhage located in the surgical area with an important oedema. The patient required a second emergency surgery without any chance of conserving the cranial vault. During the post-operational period, great neurological deterioration in orthostatic position was noticed, which resolved spontaneously in decubitus. This deficit was resolved with bone replacement afterwards. We discuss possible predisposing factors and aetiologies of this pathology.
authors.affiliation: Departamento de Neurocirugía, Complejo Hospitalario Torrecárdenas, Almería, España. Electronic address: chemand@hotmail.com.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Narro-Donate
authors.affiliation: Departamento de Neurocirugía, Complejo Hospitalario Torrecárdenas, Almería, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Huete-Allut
authors.affiliation: Departamento de Neurocirugía, Complejo Hospitalario Torrecárdenas, Almería, España.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Escribano-Mesa
authors.affiliation: Departamento de Neurocirugía, Complejo Hospitalario Torrecárdenas, Almería, España.
authors.forename: Virginia
authors.initials: V
authors.lastname: Rodríguez-Martínez
authors.affiliation: Departamento de Neurocirugía, Complejo Hospitalario Torrecárdenas, Almería, España.
authors.forename: Ascensión
authors.initials: A
authors.lastname: Contreras-Jiménez
authors.affiliation: Departamento de Neurocirugía, Complejo Hospitalario Torrecárdenas, Almería, España.
authors.forename: Jose
authors.initials: J
authors.lastname: Masegosa-González
mesh_terms: D004677:Encephalocele / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D013577:Syndrome; D014207:Trephining / Q000009:adverse effects*
keywords: Craneoplastia; Craniectomía descompresiva; Cranioplasty; Decompressive craniectomy; Herniación paradójica; Hipotensión intracraneal; Intracranial hypotension; Lumbar puncture; Paradoxical herniation; Punción lumbar; Síndrome del craniectomizado; Trephine syndrome