title: Clinical spectrum and radiographic features of the syndrome of the trephined.
abstract: OBJECTIVE
  Craniectomy is a common neurosurgical procedure. Syndrome of the trephined (ST) occurring after craniectomy results in neurologic symptoms that are reversible with cranioplasty. While well-documented, previous literature consisted of case reports, symptom spectrum and risk factors have not been well characterized.
  
  
  METHODS
  A retrospective review of 29 consecutive cases who underwent decompressive craniectomy within a 30-month period was performed. Patients were considered affected by ST if a previously stable neurological deficit improved within 3 weeks after cranioplasty. Prevalence of ST was measured and association with demographic information, clinical symptoms patterns, indication for and size of craniectomy, as well as radiological signs were tested.
  
  
  RESULTS
  Seven patients (24%) developed ST. Chronic rehabilitation arrest was more common than acute neurologic decline. Factors such as craniectomy size and patient age did not reach statistical significance in development of ST. Radiographic factors were predictive, with a sunken skin flap contour being most sensitive, while ventricular effacement was most specific.
  
  
  CONCLUSIONS
  ST may have a higher incidence than previously thought, with a chronic rehabilitation arrest being a more common presentation than an acute decline. Medical providers involved in the post surgical care and rehabilitation of these patients should maintain a high index of suspicion for ST.
authors.affiliation: Department of Neurosurgery, West Virginia University, Morgantown, USA.
authors.forename: Cara L
authors.initials: CL
authors.lastname: Sedney
authors.affiliation: Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: William
authors.initials: W
authors.lastname: Dillen
authors.affiliation: Department of Neuroscience, Marshall University, Huntington, West Virginia, USA.
authors.forename: Terrence
authors.initials: T
authors.lastname: Julien
keywords: Craniectomy; rehabilitation; trauma; trephined