case_images: PMC6744802_01
case_images: (a) Axial plain of brain computed tomography obtained before the initial surgery showing a right acute subdural hematoma, brain contusion, traumatic subarachnoid hemorrhage, and midline shift to the left side measuring approximately 1.5 cm in thickness. (b) Axial plain brain computed tomography obtained right after the initial surgery showing decompressive right frontotemporal craniectomy and improvement of the midline shift.
case_images: SNI-10-79-g001.jpg
case_images: PMC6744802_01_SNI-10-79-g001.jpg
case_images: F1
case_images: A plain brain computed tomography (CT) showed a right acute subdural hematoma (SDH), contusion of the right temporal lobe, traumatic subarachnoid hemorrhage, and midline shift to the left side [Figure 1a]. After the operation, his anisocoria improved: the right pupil was 3 mm and the left pupil was 1.5 mm, and plain brain CT showed a regression of the mass effect and midline shift [Figure 1b].
case_images: Axial plain of brain computed tomography obtained 75 min after the initial surgery showing a sinking of the skin flap and midline shift to the left side measuring approximately 1.5 cm in width.
case_images: SNI-10-79-g002.jpg
case_images: PMC6744802_01_SNI-10-79-g002.jpg
case_images: F2
case_images: An additional CT scan showed a marked midline shift from the right to the left side with brain herniation, i.e., direction opposite to the craniectomy side, compared to the previous CT [Figure 2].
case_images: Photographs obtained before the second surgery showing a markedly sunken skin flap overlying the decompressed site.
case_images: SNI-10-79-g003.jpg
case_images: PMC6744802_01_SNI-10-79-g003.jpg
case_images: F3
case_images: The scan also showed that the skin flap overlying the decompressive craniectomy site was markedly sunken [Figure 3].
case_images: (a) Axial plain brain computed tomography obtained right after the second surgery showing improvement and resolution of the midline shift, which was recognized after the initial surgery. (b) Axial plain brain computed tomography obtained 14 days after the second surgery showing no additional abnormal findings compared to that obtained after the second surgery.
case_images: SNI-10-79-g004.jpg
case_images: PMC6744802_01_SNI-10-79-g004.jpg
case_images: F4
case_images: A follow-up CT showed significant improvement of the midline shift [Figure 4a]. A follow-up CT scan 2 weeks later showed complete resolution of the midline shift [Figure 4b].