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Bruce H. Haughey and associates at the Washington University School of Medicine, St Louis, and at the University of Texas Health Science Center, San Antonio, reported to the American Academy of Otolaryngology–Head and Neck Surgery in Washington, DC, on three cases of midline cerebral shift documented by computed tomographic scanning following flap reconstruction of lateral craniofacial-craniotemporal resections. The authors reported that three other patients undergoing anterior craniofacial resection showed no evidence of intracerebral shift. They reported that the cerebral component of the cranial contents is vulnerable to rising extrinsic pressure once the rigid protective covering of the skull is removed. Intracranial pressure falls, brain compliance rises, and contralateral cerebral shift will occur. This has been documented when craniectomy alone is performed, but certainly can be accentuated when flaps filling the surgical defect add further compression by weight or swelling. They describe several strategies to decrease the likelihood of shift.
DAVIS RK. Cerebral Shift Following Lateral Craniofacial Resections and Flap Reconstruction. Arch Otolaryngol Head Neck Surg. 1989;115(4):423. doi:10.1001/archotol.1989.01860280017007
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