Ischemic cerebral and cerebellar strokes simultaneously following supratentorial cranioplasty: case report

Background: Several complications may take place following supratentorial cranioplasty, such as poor wound healing, scalp infection, epilepsy, bone flap resorption and cosmetic dissatisfaction. However, it is rare that ischemic cerebral and cerebellar strokes can simultaneously happen to patients following supratentorial cranioplasty. We present one case of ischemic cerebral and cerebellar strokes following the right supratentorial cranioplasty simultaneously. Case description: A male of 55-year-old suffered right temporal-parietal subdural hematoma and cerebral contusion and laceration after a sudden traffic accident in October 2016. Decompressive craniectomy was carried out for remitting high intracranial pressure in our hospital. In February 2017, the patient underwent the right temporal-parietal titanium mesh cranioplasty in our Department of neurosurgery. The male had no occurrence of surgery-associated adverse events intraoperatively. However, the consciousness of this patient did not return to normal and the onset of epilepsy had three times postoperatively. Six hours later, postoperative CT scan shown ischemic strokes in the right cerebral and the left cerebellar lobes. Computed tomography angiography (CTA) and Transcranial Doppler (TCD) indicated that the vascular status of the right middle cerebral artery and the left vertebral artery was poor. 7 hours after the cranioplasty, the patient was given the left suboccipital decompressive craniectomy. Medical measures concerning antiplatelet aggregation and improvement of cerebrovascular microcirculation were taken following posterior fossa decompression. The patient was discharged with normal consciousness and 0 grade of muscle tone in the left limbs. The left limbs muscle tone was restored to grade 5 after six months of follow-up. Conclusions: We present a rare case of ischemic cerebral and cerebellar infarction following supratentorial cranioplasty. CTA and TCD were applied to examine the cerebral-vascular abnormalities, reperfusion and venous stasis for Infratentorial and supratentorial infarction following supratentorial cranioplasty. The three major causes should be taken into considerations when assessing the complications of cranioplasty.