Sinking Skin Flap Syndrome or Syndrome of the Trephined: A Report of Two Cases.

Ann Rehabil Med

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Published: February 2019

Decompressive craniectomy (DC) is commonly performed in patients with intracranial hypertension or brain edema due to traumatic brain injury. Infrequently, neurologic deteriorations accompanied by sunken scalp may occur after DC. We report two patients with traumatic subdural hemorrhage who had neurologic deteriorations accompanied by sunken scalp after DC. Neurologic function improved dramatically in both patients after cranioplasty. Monitoring for neurologic deterioration after craniectomy is advised. For patients showing neurologic deficit with a sunken scalp, early cranioplasty should be considered.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6409664PMC
http://dx.doi.org/10.5535/arm.2019.43.1.111DOI Listing

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Article Synopsis
  • Cranioplasty after a decompressive craniectomy helps protect the brain and improve blood flow but can lead to serious complications like infections and sinking skin flap syndrome.
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Sinking Skin Flap Syndrome or Syndrome of the Trephined: A Report of Two Cases.

Ann Rehabil Med

February 2019

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Decompressive craniectomy (DC) is commonly performed in patients with intracranial hypertension or brain edema due to traumatic brain injury. Infrequently, neurologic deteriorations accompanied by sunken scalp may occur after DC. We report two patients with traumatic subdural hemorrhage who had neurologic deteriorations accompanied by sunken scalp after DC.

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Factors Affecting Optimal Time of Cranioplasty: Brain Sunken Ratio.

Korean J Neurotrauma

October 2017

Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.

Objective: After a rigorous management of increased intracranial pressure by decompressive craniectomy (DC), cranioplasty (CP) is usually carried out for functional and cosmetic purposes. However, the optimal timing of CP remains controversial. Our study aims to analyze the relationship between the optimal timing of CP and the post-operative complications.

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Long-Standing Scalp Retraction Technique Using an External Fixator for Sunken Skin Flap Syndrome.

Oper Neurosurg (Hagerstown)

December 2017

Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Gyeonggi-do, Republic of Korea.

Background And Importance: The authors report a novel external scalp retraction technique for sunken skin flap syndrome (SSFS).

Clinical Presentation: A 48-year-old male patient suffered neurological deterioration due to SSFS after decompressive craniectomy. Cranioplasty is the gold standard for therapeutic management of SSFS, but could not be performed due to intracranial wound infection.

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Introduction: The "Motor Trephine Syndrome (MTS)" also known as the "Sunken brain and Scalp Flap Syndrome" or the "Sinking Skin Flap Syndrome (SSFS)" or the "Syndrome of the trephined" is an unusual syndrome in which neurological deterioration occurs following removal of a large skull bone flap. This syndrome is associated with sensorimotor deficit and neurological deterioration following decompressive craniectomy which is performed for various neurosurgical conditions involving cerebral swelling causing mass effect. The neurological deterioration can be exacerbated or precipitated by CSF diversion procedures like a Ventriculo-Peritoneal shunt.

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