title: Syndrome of the trephined following bifrontal decompressive craniectomy: implications for rehabilitation.
abstract: OBJECTIVE
  The syndrome of the trephined is a rare complication observed following a unilateral decompressive craniectomy for traumatic brain injury. What has not been previously reported is the occurrence of this complication following a bifrontal procedure. The objective of this study was to present two clinical cases that serve to highlight this condition.
  
  
  METHODS
  A case study of two patients who had had a bifrontal decompressive craniectomy for severe traumatic brain injury.
  
  
  METHODS
  A review was undertaken detailing the clinical course of the two patients.
  
  
  RESULTS
  Both cases were young males. They had initially made significant improvement in their functional and cognitive performance whilst undergoing rehabilitation. However, after some months they demonstrated marked deterioration. Immediately following cranioplasty they showed considerable clinical improvement.
  
  
  CONCLUSIONS
  If the use of bifrontal decompressive craniectomies continues to increase it is important that those involved in the rehabilitation process are familiar with this rare condition. Early recognition is important so that patients can receive timely intervention and it also avoids valuable health resources being allocated to patients who cannot receive maximal benefit.
authors.affiliation: Department of Occupational Therapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Courtney
authors.initials: C
authors.lastname: Janzen
authors.forename: Kate
authors.initials: K
authors.lastname: Kruger
authors.forename: Stephen
authors.initials: S
authors.lastname: Honeybul
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D003071:Cognition; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014207:Trephining / Q000009:adverse effects*