title: Case report of MR perfusion imaging in sinking skin flap syndrome: growing evidence for hemodynamic impairment.
abstract: BACKGROUND
  The syndrome of the sinking skin flap (SSSF) with delayed sensorimotor deficits after craniectomy is not well known and often neglected. Among various postulated causes, there is evidence that disturbed brain perfusion may be related to the observed symptoms, and that cranioplasty reliably alleviates these symptoms. We report a case of sinking skin flap syndrome (SSFS) with recovery from neurological sensorimotor deficits after cranioplasty correlated with pre- and postsurgical MR brain perfusion studies.
  
  
  METHODS
  A 42-year-old woman presented with slowly progressive sensorimotor paresis of her left arm after decompressive extensive craniectomy due to subarachnoid hemorrhage four months ago. Her right cranium showed a "sinking skin flap". After cranioplastic repair of her skull defect, the patient fully recovered from her symptoms. Before cranioplasty, reduced brain perfusion in the right central cortical region was observed in MR-perfusion images. After cranioplasty, a marked increase in brain perfusion was observed which correlated with objective clinical recovery.
  
  
  CONCLUSIONS
  There is increasing evidence that impaired blood flow is responsible for delayed motor deficits in patients with sinking skin flap syndrome in the area of compressed brain regions. Symptoms should be evaluated by brain perfusion imaging complementing surgical decision-making.
authors.affiliation: Institute for Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany. akemmling@web.de
authors.forename: Andre
authors.initials: A
authors.lastname: Kemmling
authors.forename: Thomas
authors.initials: T
authors.lastname: Duning
authors.forename: Lars
authors.initials: L
authors.lastname: Lemcke
authors.forename: Thomas
authors.initials: T
authors.lastname: Niederstadt
authors.forename: Jens
authors.initials: J
authors.lastname: Minnerup
authors.forename: Heike
authors.initials: H
authors.lastname: Wersching
authors.forename: Martin
authors.initials: M
authors.lastname: Marziniak
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply*; D002560:Cerebrovascular Circulation; D003399:Craniotomy; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D010291:Paresis / Q000209:etiology / Q000601:surgery; D010292:Paresthesia / Q000209:etiology / Q000601:surgery; D055420:Perfusion Imaging; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D013524:Surgical Flaps / Q000009:adverse effects*