In situ free-floating craniectomy: an unusual cause of chronic post-traumatic cephalalgia.

Abstract

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.

• Authors: Chandrasekaran Kaliaperumal, Savitha Raveendran
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2012 (Aug 13 2012) ISSN: 1757-790X [Electronic] England
• PMID: 22891026 (Publication Type: Case Reports, Journal Article)

Topics

• Brain Injuries (complications, diagnostic imaging, surgery)
• Craniotomy (adverse effects, methods)
• Headache (etiology, surgery)
• Hematoma, Subdural, Acute (diagnostic imaging, etiology, surgery)
• Humans
• Male
• Middle Aged
• Radiography