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Syndrome of the trephined

2009; American Association of Neurological Surgeons; Volume: 111; Issue: 4 Linguagem: Inglês

10.3171/2009.3.jns0984

1933-0693

Vivek Joseph, Peter L. Reilly,

Cerebrospinal fluid and hydrocephalus

"Syndrome of the trephined" or "sinking skin flap syndrome" is an unusual syndrome in which neurological deterioration occurs following removal of a large skull bone flap. The neurological status of the patient can occasionally be strongly related to posture. A 77-year-old male patient with an acute subdural hematoma was treated using a hemicraniectomy and evacuation of the hematoma. On the 9th postoperative day there was deterioration in sensorium associated with a sunken scalp flap and worsening midline shift on CT. A significant improvement in sensorium and a filling up of the scalp flap occurred after maintaining the patient's head in a dependent position. The patient subsequently made an excellent recovery following replacement of the bone flap. The pathophysiology of "syndrome of the trephined" or "sinking skin flap syndrome" is reviewed.