1004 - Chronic Pseudomeningocele Presentation After Cranioplasty

 
A 20-year-old man with gunshot wound to the head one year prior, presenting GCS 1T4 requiring hemicraniectomy and subsequent cranioplasty presented to clinic for routine follow up. Patient continued his functional recovery, was enrolled in school, and in the process of returning to work and driving. He was doing well clinically with negative review of systems but incidentally noted several, raised, blister-like skin lesions over his cranioplasty site.  

Physical exam confirmed swelling and blister-like lesions over the left cranioplasty site. Imaging revealed increased subgaleae and intracranial fluid collection around the cranioplasty, with associated midline shift of 1cm. Subgaleae fluid aspiration revealed Gram-positive cocci, and the patient underwent cranioplasty removal and washout with long-term antibiotics. At present, the patient is recovering well postoperatively. 


Discussions:  
This case emphasizes that subtle dermatologic changes—such as blister-like lesions on the scalp—can serve as early external indicators of deeper post-cranioplasty complications. While the patient lacked systemic symptoms of infection or focal neurologic deficits, these visible skin changes led to further evaluation and timely surgical management. 

Conclusions:

 
Early identification, family vigilance, and collaborative care between PM&R and neurosurgery teams were critical in this case. This report highlights the clinical value of monitoring for skin findings in cranial surgery follow-up.