Treatment of hemispheric collapse and herniation beneath the falx in a case of shunted hydrocephalus

A successfully treated case of inversion and herniation of a cerebral hemisphere beneath the falx is reported. This condition resulted from large subdural hematomas as a complication of shunting in advanced hydrocephalus. The subdural collections were evacuated gradually while ventricular cerebrospinal fluid was replenished through the externalized ventricular catheter. The patient showed substantial recovery of neurological function. Tolerance of such massive cerebral herniation demonstrates a remarkable ability of the thin hydrocephalic cortical mantle to function after extreme distortion.