Ann Rehabil Med.  2019 Feb;43(1):111-114. 10.5535/arm.2019.43.1.111.

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

• Park HY
• Kim S
• Kim JS
• Lim SH
• Kim YI
• Lee DH
• Hong BY

• KMID: 2440959
• DOI: http://doi.org/10.5535/arm.2019.43.1.111

Abstract

Decompressive craniectomy (DC) is commonly performed in patients with intracranial hypertension or brain edema due to traumatic brain injury. Infrequently, neurologic deteriorations accompanied by sunken scalp may occur after DC. We report two patients with traumatic subdural hemorrhage who had neurologic deteriorations accompanied by sunken scalp after DC. Neurologic function improved dramatically in both patients after cranioplasty. Monitoring for neurologic deterioration after craniectomy is advised. For patients showing neurologic deficit with a sunken scalp, early cranioplasty should be considered.

Keyword

Traumatic brain injuries; Decompressive craniectomy; Neurologic manifestations

MeSH Terms

Brain Edema
Brain Injuries
Decompressive Craniectomy
Hematoma, Subdural
Humans
Intracranial Hypertension
Neurologic Manifestations
Scalp
Skin*

Figure

• 

  Fig. 1. Brain images of Case 1. (A) Traumatic subdural hemorrhage on the right frontotemporal lobe. (B) The follow-up brain computed tomography (CT) showing increased hemorrhage and midline shifting to the left side. (C) Magnetic resonance imaging showing midline shifting with sunken scalp of the right frontotemporal lobe. (D) Brain CT after cranioplasty.

• 

  Fig. 2. Brain images of Case 2. (A) Traumatic subdural hemorrhage on the right frontotemporal lobe. (B) The follow-up brain computed tomography (CT) showing increased hemorrhage and midline shifting to the left side. (C) Magnetic resonance imaging showing midline shifting with sunken scalp of the right frontotemporal lobe. (D) Brain CT after cranioplasty.

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