Syndrome of the trephined.
"Syndrome of the trephined" or "sinking skin flap syndrome" is an unusual syndrome in which neurological deterioration occurs following removal of a large skull bone flap. The neurological status of the patient can occasionally be strongly related to posture. A 77-year-old male patient with an acute subdural hematoma was treated using a hemicraniectomy and evacuation of the hematoma. On the 9th postoperative day there was deterioration in sensorium associated with a sunken scalp flap and worsening midline shift on CT. A significant improvement in sensorium and a filling up of the scalp flap occurred after maintaining the patient's head in a dependent position. The patient subsequently made an excellent recovery following replacement of the bone flap. The pathophysiology of "syndrome of the trephined" or "sinking skin flap syndrome" is reviewed.
Joseph
Vivek
V
Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India. vivek.joseph@cmcvellore.ac.in
Reilly
Peter
P
D000368:Aged; D001927:Brain Diseases / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods; D004244:Dizziness / Q000209:etiology / Q000503:physiopathology; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology; D006261:Headache / Q000209:etiology / Q000503:physiopathology; D006406:Hematoma / Q000601:surgery; D006408:Hematoma, Subdural / Q000601:surgery; D006801:Humans; D008297:Male; D011187:Posture / Q000502:physiology; D011379:Prognosis; D013524:Surgical Flaps / Q000009:adverse effects*; D013577:Syndrome; D014207:Trephining / Q000009:adverse effects*