Figure 1
Lateral and anteroposterior skull radiographs (A) and (B) a 55-year-old man who underwent craniotomy shows two metallic cover plates or craniofix (Aesculap) on the left side of the posterior fossa (A, arrows). Axial CT on skull window (C) and (D) of the same man shows the metallic cover plates.
Figure 2
Axial brain CT of a 22-year-old man who underwent right hemicraniectomy. After resolution of the cerebral edema and mass effect, the pathological side of the brain appears “sunken” (A). This appearance is also known as “Motor Trephine Syndrome (MTS)” or “Sunken Brain and Scalp Flap Syndrome” (SSFS). This condition is further aggravated by CSF diversion procedures such as ventriculo-peritoneal shunt. Note of the ventricular catheter tip in the left frontal horn. He subsequently underwent titanium cranioplasty with pneumocephalus underneath the titanium implant (B). There is interval improvement following cranioplasty with improvement of the patients’ neurological and cognitive functions. A few weeks later, he developed a late postoperative complication with hydrocephalus due to shunt dysfunction (C).
Figure 3
Axial CT, brain window (A) and skull bone window (B) images of a 50-year-old man demonstrate a right temporo-parietal acrylic cranioplasty using methylmethacrylate (MMA) material which is prefabricated and created with computer-aided design 3D CT data set of the skull defect. Acrylic cranioplasty appears radiolucent on CT and occasionally with mixed intermediate and low attenuation. It may contain gas bubbles formed during exothermic polymerization hence, it should not be mistaken for infection. (C) Is from a 48-year-old man with increasing scalp swelling following insertion of a polyetheretherketone (PEEK) cranioplasty with accumulation of large amount of extra-axial fluid collection containing gas on either side of the PEEK cranioplasty and causing mass effect on the underlying cerebrum. There was suspicion of infection of the affected PEEK cranioplasty, which was subsequently removed. The culture grew staphylococcus aureus. The patient recovered gradually following treatment with appropriate intravenous antibiotics.
Figure 4
Axial brain CT of a 68-year-old man with bilateral titanium cranioplasty, who developed pneumocephalus five years after surgery due to erosion of the titanium plate through a left frontal scalp wound (A, arrow). Pneumocephalus compressed both frontal lobes resulting in a tented appearance of the brain known as the Mount Fuji sign, indicative of tension pneumocephalus (B). After removal of the titanium plate, the scalp was reconstructed with a rotation flap and skin graft.
Figure 5
Axial brain CT of a 45-year-old woman who had right decompressive hemicraniectomy for evacuation of a right basal ganglia hemorrhage. She developed hydrocephalus for which a left frontal external ventricular catheter was inserted (A). Coronal CT (B) shows post catheterization improvement of the hydrocephalus (B). During removal of the ventricular catheter, the procedure was complicated by development of an acute left subdural and intraparenchymal hemorrhage along the catheter track seen on the axial CT (C).
Figure 6
Coronal CT image of a 57-year-old man with severe brain injury who underwent insertion of a right frontal intracranial pressure (ICP) monitoring probe (A) demonstrates an acute intraparenchymal hematoma at the tip of the ICP monitoring probe. Axial CT brain of a 54-year-old man (B) shows ventricular catheter of a right parietal ventriculoperitoneal shunt abutting the septum pellucidum. The ventricles are slit-like. Coronal post-contrast T1-Weighted MRI of the man (C) confirms slit-like ventricles along with pachymeningeal thickening and enhancement. This is consistent with intracranial hypotension due to over-drainage of CSF.
Figure 7
Axial post-contrast T1-weighted MRI of the brain reveals rim-enhancing collections in the right frontal lobe (A) and the right lateral ventricle (B). In addition, there is linear enhancement along the right parietal approached ventricular catheter. These findings are compatible with shunt-related ventriculitis and cerebral abscess.
Figure 8
A 64-year-old man with medically intractable Parkinsonism underwent bilateral deep brain stimulator (DBS) insertion. The left stimulator electrode is connected to a battery-powered internal pulse generator in a subcutaneous pouch in the left pectoral region (A). A few weeks after surgery, he developed fever and headache. Coronal post-contrast T1-weighted MRI (B) reveals a rim enhancing lesion at the tip of a DBS electrode in the left subthalamic region consistent with an intraparenchymal abscess. It is associated with marked perilesional oedema. Surgical removal of the infected DBS stimulator electrode was subsequently performed. The culture obtained from the removed electrode grew Staphylococcus Aureus. He was given appropriate treatment with intravenous antibiotics for six weeks.