Importance of Early Cranioplasty in Reversing the “Syndrome of the Trephine/Motor Trephine Syndrome/Sinking Skin Flap Syndrome”

Jeyaraj, Priya

doi:10.1007/s12663-014-0673-1

Cited by 52 publications

(32 citation statements)

References 19 publications

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“…The SoT is a progressive neurologic deterioration that affects 1.2% to 24% of patients with large craniectomy defects resulting from various indications. Loss of intracranial domain generates negative pressure gradients across the brain, leading to cortical compression and alterations in cerebral blood and CSF flow [3]. These effects manifest clinically as a deterioration of sensorimotor, behavioral, and cognitive function [3].…”

Section: Discussionmentioning

confidence: 99%

“…Loss of intracranial domain generates negative pressure gradients across the brain, leading to cortical compression and alterations in cerebral blood and CSF flow [3]. These effects manifest clinically as a deterioration of sensorimotor, behavioral, and cognitive function [3]. Average time to symptom onset is 5 months post-craniectomy but can span from 3 days to 7 years after cranial bone removal [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…Onset of symptoms may be acute or chronic, but the average time to presentation is 5 months after craniectomy [1]. The pathophysiology of this syndrome is theorized to begin with the loss of intracranial domain, which permits atmospheric pressure to compress the brain, thereby restricting cerebral perfusion and cerebrospinal fluid (CSF) flow [1-3]. The change in hydrodynamics subsequently alters metabolic pathways, contributing to cortical dysfunction over time [2].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report

et al. 2019

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The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed—correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report

et al. 2019

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“…A typical subacute or chronical onset of SSFS is associated with a large DC with no other provoking factors being present except a positional change and dehydration [17,18,19,20]. SSFS with a more acute onset may occur in situations with a present CSF leak or diversion such as in patient with an implanted ventriculo-peritoneal shunt [6,11,16,21,22,23,24] or external lumbar drainage [25]. If the volume of intracranial contents is swiftly lowered, such as during hyperventilation or after administration of osmotic diuretics, the SSFS can also develop [1,3].…”

Section: Discussionmentioning

confidence: 99%

Sinking Skin Flap Syndrome and Paradoxical Herniation Provoked by a Malfunction of External Lumbar Drainage and CSF Leak

Hanko

Snopko

Opšenák

et al. 2019

Acta Medica Martiniana

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The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. It is defined as a neurological deterioration accompanied by a flat or concave deformity of the craniectomy-related skin flap. The underlying brain parenchyma is distorted correspondingly with its blood flow and metabolism being impaired and cerebrospinal fluid hydrodynamics being disturbed, thus causing cerebral dysfunction and neurological symptomatology. The most important options for reversal of this syndrome include Trendelenburg position, maintaining of the cerebrospinal fluid balance, and cranioplasty as a definite solution. We present a patient who underwent a decompressive craniectomy complicated by a cerebrospinal fluid leak in the operative wound treated by means of an external lumbar drainage. Subsequently he developed the sinking skin flap syndrome and a paradoxical cerebral herniation after the drainage system malfunction with a massive cerebrospinal fluid leak at the site of the lumbar drain insertion parallel to the drain itself. His symptoms were, however, successfully alleviated by a positional change, rehydration, and interruption of the lumbar drainage. This illustrational case suggests that clinicians should be aware that patients after decompressive craniectomy may develop a sinking skin flap syndrome as it may either represent an acute risk of a paradoxical brain herniation or complicate the further postoperative care if developed in a chronic way.

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“…These patients present with sensorimotor deficit and neurological deterioration, which can be aggravated by CSF diversion procedures such as ventriculoperitoneal (VP) shunts (Figure 2A and 2B). According to some authors [2], patients with MTS or SSFS may benefit from an early cranioplasty, which has been shown to improve the “sunken” brain with subsequent improvement of patients’ neurological and cognitive functions (Figure 2B). Early cranioplasty for MTS may therefore serve as a therapeutic procedure rather than being merely cosmetic [2].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Imaging of Complications Following Cranial Implants

McAdory

2019

Journal of the Belgian Society of Radiology

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A wide range of neurosurgical implants, cranioplasty materials and catheters have been developed to treat a variety of intracranial disorders. Interpretation of postoperative imaging can be challenging and confounded by postoperative changes and implant-related complications. Review of recent literature suggested that there is a paucity of data on postoperative cranial implant-related complications.If not addressed appropriately in a timely manner, these complications may cause a delay in the patient’s treatment with subsequent prolongation of hospital stay. It is therefore paramount for clinicians and radiologists to be aware of the appearance of these implant-related complications on imaging during postoperative surveillance.

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Importance of Early Cranioplasty in Reversing the “Syndrome of the Trephine/Motor Trephine Syndrome/Sinking Skin Flap Syndrome”

Cited by 52 publications

References 19 publications

Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report

Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report

Sinking Skin Flap Syndrome and Paradoxical Herniation Provoked by a Malfunction of External Lumbar Drainage and CSF Leak

Postoperative Imaging of Complications Following Cranial Implants

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