case_images: PMC10158666_01
case_images: The initial head CT showed a right ASDH, with an extensive LDA in the right cerebral hemisphere, midline shift, and disruption of the sagittal and lambda sutures (a). Illustration of the concept of the inverted gull-wing hinge decompression craniotomy (b). Immediately after surgery, CT showed sufficient decompression (c). Three weeks after craniotomy, MR imaging showed the right motor cortex remained (d), and MR angiography showed postcommunicating artery was adult-type only on the ipsilateral side and fetal-type on the contralateral (e). CT: Computed tomography, ASDH: Acute subdural hematoma, LDA: Area of low density, MR: Magnetic resonance
case_images: BC-9-35-g001.jpg
case_images: PMC10158666_01_BC-9-35-g001.jpg
case_images: F1
case_images: She was referred to our department for urgent decompressive craniotomy [Figure 1]. The left insufficiency paralysis and hemilateral spatial neglect were improved by rehabilitation [Figure 1].
case_images: Three weeks after craniotomy, 3D-CT showed somewhat invaginated occipital bone and narrowed the sagittal and lambda sutures due to the decompression craniotomy (a). Illustration of the concept of the cranioplasty with resorbable substitute dura (b). On the first postcranioplasty day, 3D-CT showed an inverted gull-wing hinge bone flap was fixed without gaps (c). Six months after the transfer, 3D-CT showed the osteotomy line had fused without aseptic bone-flap resorption (d). 3D: Three dimensional, CT: Computed tomography
case_images: BC-9-35-g002.jpg
case_images: PMC10158666_01_BC-9-35-g002.jpg
case_images: F2
case_images: However, based on the postoperative CT imaging, we were concerned about the risk of posterior cranial growth inhibition, iatrogenic growing skull fracture, and uneven cranial bone growth due to suture failure and decompression craniotomy [Figure 2]. Her development was generally in line with her age, although she had not fully recovered from her disability [Figure 2].