El creciente auge actual del uso de la craniectomía descompresiva conlleva implícita la aparición de complicaciones derivadas de la alteración en la presión barométrica intracraneal y del equilibrio tanto hidrostático como hemodinámico. La herniación paradójica transtentorial («paradoxycal transtentorial herniation») representa una rara manifestación, englobada dentro del síndrome del craniectomizado, de extrema gravedad y de tratamiento relativamente simple. Presentamos el caso de una mujer de 56 años, sin antecedentes de interés, que tras ser intervenida de un meningioma del surco olfatorio presenta un hematoma en el lecho quirúrgico con abundante edema, requiriendo una segunda intervención de urgencia sobre este sin posibilidad de realizar la reposición ósea. Durante el posoperatorio se observa un gran deterioro neurológico de la paciente con el ortostatismo, que se resolvía espontáneamente con el decúbito y que se solventa con la reposición ósea posteriormente. Se analizan los posibles factores predisponentes y las posibles etiologías del cuadro.
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.
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