title: Sinking skin flap syndrome and paradoxical herniation secondary to lumbar drainage.
abstract: OBJECTIVE
  Decompressive craniectomy (DC) has been regaining popularity in the field of neurosurgery because it can alleviate intracranial hypertension and brain swelling. Lumbar drainage (LD) is affective in managing numerous neurosurgical circumstances such as aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, cerebrospinal fluid (CSF) leakage and intraoperative brain relaxation. Sinking skin flap syndrome (SSFS) or paradoxical herniation (PH) is a rare complication and sporadically occurs in patients after DC. Hereby, we report for the first time that DC patients with LD can progress to SSFS or PH. We also evaluated the risk factors for the incidence of SSFS in DC patients with LD.
  
  
  METHODS
  We retrospectively assessed 37 patients who underwent DC and LD for cerebrovascular diseases from the First Hospital of Jilin University between January, 2007 and December, 2012.
  
  
  RESULTS
  Nine (4 male and 5 female) of 37 patients experienced SSFS or PH following LD. At the last follow-up (mean 9 months, range 6-12 months), eight patients recovered completely due to timely conservative management and one patient died from PH. The mortality rate was 11% (1/9) from the complications of PH or SSFS. Further statistical analysis revealed that mean daily CSF volume was a risk factor for the incidence of SSFS in DC patients with LD.
  
  
  CONCLUSIONS
  SSFS or PH can be identified in DC patients following LD. Patients that undergo DC and LD should be monitored more intensively. Most patients can completely recover with timely conservative management, bed rest, Trendelenburg position, sufficient intravenous fluid, and temporary clipping of the catheter.
authors: Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.
authors: Jinchuan
authors: J
authors: Zhao
authors: Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.
authors: Guichen
authors: G
authors: Li
authors: Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.
authors: Yang
authors: Y
authors: Zhang
authors: Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.
authors: Xiaobo
authors: X
authors: Zhu
authors: Department of Neurosurgery, First Hospital of Jilin University, Changchun, China. Electronic address: hkyyayz@yeah.net.
authors: Kun
authors: K
authors: Hou
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D002555:Cerebrospinal Fluid; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology* / Q000628:therapy; D012307:Risk Factors; D012535:Scalp / Q000473:pathology; D013577:Syndrome; D016896:Treatment Outcome; D014207:Trephining / Q000009:adverse effects*
keywords: Decompressive craniectomy; Lumbar drainage; Paradoxical herniation; Sinking skin flap syndrome