title: Asymmetric optic nerve sheath diameter as an outcome factor following cranioplasty in patients harboring the 'syndrome of the trephined'.
abstract: Decompressive craniectomy (DC) is gaining an increasing role in the neurosurgical treatment of intractable intracranial hypertension, but not without complications. A rare complication is the "syndrome of the trephined" (ST). It occurs when the forces of gravity overwhelm intracranial pressures, leading the brain to become sunken.
  
  
  OBJECTIVE
  To determine the usefulness of asymmetric optic nerve sheath diameter (ONSD) as an outcome factor after cranioplasty.
  
  
  METHODS
  We followed-up 5 patients submitted to DC and diagnosed with ST. All were submitted to brain MRI to calculate the ONSD.
  
  
  RESULTS
  Only two patients presented an asymmetric ONSD, being ONSD larger at the site of craniectomy. Surprisingly these patients had a marked neurological improvement after cranioplasty. They became independent a week after and statistically earlier than others.
  
  
  CONCLUSIONS
  It is presumed that the presence of an asymmetric ONSD in trephined patients is an independent factor of good outcome after cranioplasty.
authors.affiliation: Hospital Sírio-Libanês, Brazil, Sao PauloSP.
authors.forename: Antonio Santos de
authors.initials: AS
authors.lastname: Araujo Junior
authors.affiliation: Hospital Sírio-Libanês, Brazil, Sao PauloSP.
authors.forename: Pedro Alberto
authors.initials: PA
authors.lastname: Arlant
authors.affiliation: Hospital Sírio-Libanês, Brazil, Sao PauloSP.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Salvestrini
authors.affiliation: Hospital Sírio-Libanês, Brazil, Sao PauloSP.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Altieri
authors.affiliation: Hospital Sírio-Libanês, Brazil, Sao PauloSP.
authors.forename: Jasper Guimarães
authors.initials: JG
authors.lastname: Santos
authors.affiliation: Hospital Sírio-Libanês, Brazil, Sao PauloSP.
authors.forename: Lauro Figueira
authors.initials: LF
authors.lastname: Pinto
authors.affiliation: Hospital Sírio-Libanês, Brazil, Sao PauloSP.
authors.forename: Mirella Martins
authors.initials: MM
authors.lastname: Fazzito
authors.affiliation: Hospital Sírio-Libanês, Brazil, Sao PauloSP.
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Hospital Sírio-Libanês, Brazil, Sao PauloSP.
authors.forename: Luis Felipe de Souza
authors.initials: LF
authors.lastname: Godoy
mesh_terms: D000368:Aged; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019586:Intracranial Hypertension / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009900:Optic Nerve / Q000473:pathology*; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D013577:Syndrome; D016896:Treatment Outcome; D014207:Trephining / Q000009:adverse effects*; D055815:Young Adult