Craniectomy-Associated Progressive Extra-Axial Collections with Treated Hydrocephalus (CAPECTH)

 

CAPECTH:  accumulation of extra-axial fuid collection that follows decompressive craniectomy

Proposed Pathophysiology:  Surgery violates the dural and bony tissue planes and creates communication among the distinct spaces (subgaleal, epidural, subdural, subarachnoid), thus forming the fluid collection.

 

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Figure.  Axial noncontrast head CT scans showing a brainstem compression from mass effect; b a large collection slightly denser than cerebrospinal fluid with significant mass effect; and c the collection resolved after cranioplasty and ventriculoperitoneal shunt placement

 

These collections can sometimes behave in an aggressive fashion, causing mass effect, herniation and significant worsening in clinical status.

 

Treatment algorithm for CAPECTH

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References

Huang, Kevin T. et al. “The Neurocritical And Neurosurgical Care Of Subdural Hematomas”.Neurocritical Care 24.2 (2015): 294-307. Web.

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