Sinking Skin Flap Syndrome or Syndrome of the Trephined: A Report of Two Cases

Park, Hae-Yeon; Kim, Sehee; Kim, Joon-Sung; Lim, Seong Hoon; Kim, Young Il; Lee, Dong Hoon; Hong, Bo Young

doi:10.5535/arm.2019.43.1.111

Cited by 6 publications

(2 citation statements)

References 10 publications

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“…Triple F therapy, (1) flat head end, (2) fluid administration, and (3) flap replacement (autologous bone or mesh), is the cornerstone of the management of SFS [27]. The role of early cranioplasty in SFS is not wellelaborated, but some studies have shown the advantageous effect of early cranioplasty in SFS [28,29]. Since SFS is a sequelae of PTH following shunt procedures, we propose that early cranioplasty should be considered in patients of PTH following DCs with MFHI > 43, although to verify this statement, we need more large scale prospective cohorts.…”

Section: Discussionmentioning

confidence: 99%

Modified frontal horn index: a novel risk predictor for sunken flap syndrome in the patients undergoing shunt procedures for post-decompressive craniectomy hydrocephalus

Yadav,

Sahu,

Prasad

et al. 2024

Egypt J Neurol Psychiatry Neurosurg

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Background Decompressive craniectomy (DC) is a neurosurgical procedure, frequently used in lowering the refractory intracranial pressure (ICP) following traumatic brain injuries. Post-traumatic hydrocephalus (PTH), a debilitating complication in the patients with traumatic brain injuries, occurs in 11.9–36% patients undergoing DCs. Sunken flap syndrome (SFS) is a rare entity, following DCs or cerebrospinal fluid (CSF) diversion procedures for PTH after DCs and leads to neurological deterioration of the patients. Literature regarding risk factors associated with SFS in the patients undergoing ventriculoperitoneal shunt procedures for hydrocephalus following DCs is scarce. The aim of this study is to determine the incidence of SFS and to establish a relationship between several clinico-radiological features and SFS in patients undergoing shunt procedures for PTH. Results This retrospective study was conducted in a tertiary care trauma centre upon 60 patients who underwent shunt procedures for PTH. Intraventricular haemorrhage (P < 0.0001), communicating-type hydrocephalus (P = 0.0006), and modified frontal horn index (P < 0.0001) were significantly associated with development of SFS. MFHI > 43 was a significant risk factor in development of SFS. Conclusions SFS is the common complication following shunt procedures for PTH after DCs. MFHI is significant risk predictor for SFS. MFHI > 43 is associated with higher chances of developing SFS following shunt insertion in PTH. Early cranioplasty following DCs might prevent development of SFS.

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Section: Discussionmentioning

confidence: 99%

Modified frontal horn index: a novel risk predictor for sunken flap syndrome in the patients undergoing shunt procedures for post-decompressive craniectomy hydrocephalus

Yadav,

Sahu,

Prasad

et al. 2024

Egypt J Neurol Psychiatry Neurosurg

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“…Urgent operative intervention is rarely indicated; however, in patients who do not improve with conservative treatment, early cranioplasty is most effective in relieving symptoms [ 6 ]. Early cranioplasty remains a life-saving measure to perform when midline shifting is confirmed by CT and does result in better outcomes for these patients [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Sinking Skin Flap Syndrome After Decompressive Hemicraniectomy in a Patient With Calvarial Multiple Myeloma Who Underwent a Lumbar Puncture: A Case Report

Tonini¹,

Jordanovski²,

Williams³

2022

Cureus

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Sinking skin flap syndrome (SSFS) or “syndrome of the trephined” is a rare complication that can occur after decompressive craniectomy. Disabling neurologic deficits, as well as the impairment of overall mental status with the development of a concave deformity and relaxation of the skin flap, are frequently observed. This usually develops several weeks to months after craniectomy. The pathophysiology of the syndrome includes cerebrospinal fluid (CSF) hypovolemia and the development of an atmospheric pressure gradient that can be worsened by CSF diversion, dehydration, and change in position such as can be seen with a lumbar puncture. We present a case of a 40-four-year-old male with calvarial multiple myeloma three months after craniectomy who developed SSFS two days after lumbar puncture was performed to investigate possible leptomeningeal spread. It is imperative to recognize the syndrome early and proceed with urgent management with measures that initially increase intracranial pressure such as IV hydration and Trendelenburg positioning. In certain cases, proceeding with surgical management, such as epidural patch or cranioplasty, can be life-saving.

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Historical Vignette Portraying the Difference Between the “Sinking Skin Flap Syndrome” and the “Syndrome of the Trephined” in Decompressive Craniectomy

Beucler¹,

Dagain²

2022

World Neurosurgery

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Sinking Skin Flap Syndrome or Syndrome of the Trephined: A Report of Two Cases

Cited by 6 publications

References 10 publications

Modified frontal horn index: a novel risk predictor for sunken flap syndrome in the patients undergoing shunt procedures for post-decompressive craniectomy hydrocephalus

Modified frontal horn index: a novel risk predictor for sunken flap syndrome in the patients undergoing shunt procedures for post-decompressive craniectomy hydrocephalus

Sinking Skin Flap Syndrome After Decompressive Hemicraniectomy in a Patient With Calvarial Multiple Myeloma Who Underwent a Lumbar Puncture: A Case Report

Historical Vignette Portraying the Difference Between the “Sinking Skin Flap Syndrome” and the “Syndrome of the Trephined” in Decompressive Craniectomy

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