3. Edema continued to progress, but edema and. Concave deformity of the right hemisphere with a contralateral midline shift is apparent. A 77-year-old male patient with an acute subdural hematoma was. As the herniated brain tissue recedes, the skin flap from the surgical site can become sunken. . It is defined as a neurological deterioration accompanied by a flat or concave. edu Academia. [ 2] The spectrum of symptoms resulting from this syndrome can range from seizures, headache, neurospsychiatric disturbance, focal weakness, midbrain syndromes, [ 3] and Parkinsonian symptoms. The primary goals of cranioplasty after DC are to protect the brain, achieve a natural appearance and prevent sinking skin flap syndrome (or syndrome of the trephined). The sinking flap syndrome (SFS) is one of the complications of decompressive craniectomy (DC). Syndrome of the trephined, or sinking skin flap syndrome, is a rare complication following craniectomy, showing a variety of neurological symptoms that improve after cranioplasty. Sinking flap syndrome revisited: the. This is a complication that occurs in patients with large cranial defects following a DC. ・感染. Sinking skin flap syndrome (SSFS) is a complication among long-term survivors of stroke or traumatic brain injury treated by decompressive craniectomy. The neuro-intensive care team should be prepared to diagnose. Injury 37:1125-1132 (PMID: 17081545) [2] Akins PT, Guppy KH (2008) Sinking skin flaps, paradoxical herniation, and external brain tamponade: a review of. Semantic Scholar's Logo. Sinking skin flap syndrome, resulting from decompressive craniectomy, is defined as a series of neurologic symptoms with skin depression at the site of cranial defect. Sinking skin flap syndrome is defined as a series of neurologic symptoms with the skin depression at the site of cranial defect, which develop several weeks to months after large external cerebral decompression. Sinking skin flap syndrome is defined as a series of neurologic symptoms with the skin depression at the site of cranial defect, which develop several weeks to months after large external cerebral decompression. Brainstem hemorrhages classify as primary or secondary. Sinking skin flap syndrome is defined as a series of neurologic symptoms with the skin depression at the site of cranial defect, which develop several weeks to months after. Sinking skin flap syndrome is a rare complication of decompressive craniectomy characterized by a sunken skin flap, neurological deterioration, and paradoxical herniation of the brain. Skip to search form Skip to main content Skip to account menu. A patient of sinking brain and skinIntroduction: Complications following craniotomy are not uncommon and Sinking Skin Flap Syndrome (SSFS) constitutes a rare entity that may present after a large Decompressive Craniectomy. 2 became effective on October 1, 2023. A 61-year-old male was. An absent cranium allows for external compression via atmospheric pressure, causing alterations in cerebral blood flow, cerebral spinal fluid. (37) studied the syndrome of the sinking skin flap (SSSF), described as one of the causes of new neurological deterioration after a large craniectomy, using dynamic CT and xenon CT to evaluate cerebral blood flow (CBF) (12, 37, 45, 46). 8) In 1977, Yamaura et al. Neurologic. Case presentation • Young male patient , 32 years old • He had Right MCA territory infract 3. 2 cm(2) versus 88. A 61-year-old male was. Spontaneous bone healing occurred in all the survived cases and completed several months after surgery due to the difference of age (Fig. This usually. The first case of sinking skin flap syndrome was reported by Yamamura et al. Background: Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. Forty years later, in 1977, the sinking skin flap syndrome was defined as new-onset neurologic deficits or even coma associated with marked skin depression at the site of craniectomy, indicating urgent. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a. Once the computed tomography scan shows malignant cerebral swelling, the patient is expected to have a poor prognosis. The problem was considered to have been asymptomatic sinking skin flap syndrome (SSFS). The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. Gadde, J, Dross, P, Spina, M. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. The sinking skin flap syndrome is a rare complication after a large craniectomy. Cranioplasty using an original bone flap,. The final reference list was generated on the basis of its relevance to the topics covered in this review. A 20-year-old male. Introduction. "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. Sinking skin flaps, paradoxical herniation, and external brain tamponade: a review of decompressive craniectomy management. Sinking skin flap syndrome or “syndrome of the trephined” is a rare complication after a large craniectomy, with a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or. Sinking Skin Flap syndrome References [1] Timofeev I, Hutchinson PJ (2006) Outcome after surgical decompression of severe traumatic brain injury. [1] The latter is known as Duret hemorrhages (DH) named after a French. Atmospheric pressure and gravity overwhelm. Zusammenfassung. in the following article: Paradoxical brain herniation - “ Paradoxical brain herniation, also known as sinking skin flap syndrome or syndrome of the trephined, is a rare and potentially fatal complication. The subsequent neurological workup for TIA, including normal Duplex carotid vertebral ultrasound, was unremarkable. On the basis of these data, we propose a classificationSinking skin flap syndrome, also known as syndrome of the trephined, occurs in decompressive craniectomy patients. J Surg Case Rep. Hereby, we report for the first time that DC patients with LD can progress to SSFS or PH. Sinking skin flap syndrome, or syndrome of trephined, seems as a DC-related complication in the first several weeks and months after DC. All studies were case reports and small case series. There were no language restrictions. Sinking skin flap syndrome is rare phenomenon that occurs in patients with large craniectomies. A 77-year-old male patient with an acute. Sinking skin flap syndrome is a catastrophic delayed complication in patients who underwent craniectomy for various reasons. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a. Sinking skin flap syndrome, resulting from decompressive craniectomy, is defined as a series of neurologic symptoms with skin depression at the site of cranial defect. Fig. The sinking skin flap syndrome (SSFS) or syndrome of the trephined is a rare complication that occurs in approximately 10% of large craniectomies and tends to develop several weeks to several months after surgery. . His condition was complicated with ventilator associated pneumonia, and was treated with IV Fortum and Cefepime. These 2 syndromes illustrate the paradigm shift of the indications for cranioplasty, which have evolved from cosmetic. Perfusion magnetic resonance imaging showed subclinical sinking skin flap syndrome, and he underwent cranioplasty on postoperative day 58. Sinking skin flap syndrome (SSFS) or “syndrome of the trephined” is a rare complication that can occur after decompressive craniectomy. Sinking skin flap syndrome (SSFS) or "syndrome of the trephined" is a rare complication that can occur after decompressive craniectomy. Sinking skin flap syndrome is a rare complication of decompressive craniectomy characterized by a sunken skin flap, neurological deterioration, and paradoxical herniation of the brain. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. It results from an intracerebral hypotension and requires the replacement of the cranial flap. It appears in the weeks or months (3 months in average) after the surgery and is characterized by a neurological deterioration, not explained by other etiologies. Admitted with Glascow score of 13/15, rapid neurological deterioration was noted with a GCS of 9/15, and then. This syndrome is associated with sensorimotor deficit. This usually. 3109/02688697. The main trouble in. ADLs, activities of daily livingCBF, cerebral blood flowSoT, syndrome of the trephinedVP, ventriculoperitoneal. Finally, we present our obser-vations on a small group of subjects presenting with asymp-tomatic sinking skin flaps, in a further effort to highlight pos-sible factors influencing the physiopathology of the syn-drome. Introduction. DOI: 10. The “Motor Trephine Syndrome (MTS)” also known as the “Sunken brain and Scalp Flap Syndrome” or the “Sinking Skin Flap Syndrome (SSFS)” or the “Syndrome of the trephined” is an unusual syndrome in which neurological deterioration occurs following removal of a large skull bone flap. During his irst follow-up at theSinking skin flap syndrome with delayed dysautonomic syndrome—An atypical presentation . ICU勉強会 担当：S先生. Sinking skin flap syndrome, paradoxical herniation (more on these below). It results from the pressure difference between the atmospheric pressure and the intracranial pressure causing the brain to shift inward at the craniectomy site. Thieme E-Books & E-Journals. ST is also known as “sinking skin flap syndrome” and typically occurs in the weeks to months following operation. Sinking skin flap syndrome in the multi-trauma patient: a paradoxical management to TBI post craniectomy. The syndrome describes a cluster of symptoms including depressed mood, headache, behavioral disturbance, and seizure related to cerebral cortex distortion under the skin flap once cerebral edema subsides. It was first described by Grant and Norcross in 1939 as a constellation of symptoms including dizziness, undue fatigability, discomfort at the defect. M95. The "Motor Trephine Syndrome (MTS)" also known as the "Sunken brain and Scalp Flap Syndrome" or the "Sinking Skin Flap Syndrome (SSFS)" or the "Syndrome of the trephined" is an unusual syndrome in. The symptoms following large craniectomy were reported to described the "syndrome of the trephined (ST)"or "sinking skin flap syndrome (SSFS)" 13, 27, 30), while Gardner (1945) 12) reported clinical improvement after cranioplasty with tantalum repair. Zusammenfassung. Knowing that the mechanism of SSSF has been speculated to be the result of the. This can present with either nonspecific symptoms. Background: Syndrome of the trephined (ST) refers to the rare, reversible event of neurological deterioration following craniectomy. 2 cm(2) versus 88. Als Sinking Skin Flap Syndrom wird die Symptomkombination aus Einsinken des Hautlappens und des darunter liegenden Hirnparenchyms im Bereich einer großen Kraniektomie, wie beispielsweise bei einer Hemikraniektomie und einer sekundären neurologischen Verschlechterung, unabhängig von der primären Erkrankung, bezeichnet. Sinking Skin Flap Syndrome: Cause of Secondary Neurological Deterioration (PDF) Sinking Skin Flap Syndrome: Cause of Secondary Neurological Deterioration | RABII MOHAMED - Academia. The neurological status of the patient can occasionally be strongly related to posture. In this case report,. Trephine syndrome, also known as the sinking skin flap syndrome, is a relatively late complication in post-craniectomy patients. The syndrome of the sinking skin flap was introduced to explain neurological deterioration after decompressive craniectomy3. This phenomenon may result from CSF hypovolemia, atmospheric pressure gradient that may be aggravated by CSF diversion, dehydration, and position change 4, 7). Also known by other names such as syndrome of the “trephined,” it consists of sunken skin above the bone defect along with neurological. Although frequently presenting with aspecific. Introduction: Sinking skin flap syndrome or "syndrome of the trephined" is a rare complication after a large craniectomy, with a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. Sinking skin flap syndrome (SSFS) is a rare neurological complication in patients with traumatic haemorrhage, stroke or cerebral oedema who undergo decompressive craniectomy to relieve increased intracranial pressure. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have. This can present with either nonspecific symptoms. org Background and Purpose— “Sinking skin flap” (SSF) syndrome is a rare complication after large craniectomy that may progress to “paradoxical” herniation as a consequence of atmospheric pressure exceeding intracranial pressure. 2012 Oct;8(2):149-152. The case of a 28-year-old female with the sinking skin flap syndrome is reported together with the evaluation of cerebral blood flow using xenon computed tomography (CT). Craniectomy. Sinking skin flap syndrome is a rare and potentially fatal complication of a decompressive craniectomy. 7 Classically, SSFS tends to occur in the upright position and to resolve in the Trendelenburg position, which could help to detach. Sinking skin flap syndrome, also known as “syndrome of the trephined,” is an uncommon complication after decompressive craniectomy. The problem was considered to have been asymptomatic sinking skin flap syndrome (SSFS). “Sinking skin flap syndrome” (SSFS) is defined as a secondary neurological deterioration in the presence of a sinking skin flap in patients with large craniectomies. It consists of a sunken scalp. The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. Sinking skin flap syndrome or "syndrome of the trephined" is a rare complication after a large craniectomy, with a sunken skin above the bone defect with neurological symptoms such as severe. . 3340/jkns. 2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Finding a concave scalp flap after decompressive craniotomy, particularly if the patient has been shunted, is not unusual. drain, venous stasis, vascular damage following restoration of midline shift, and allergic reaction. Presentation of case: We report a case of 21 years old man with trefinated. It was first described by Grant and Norcross in 1939 as a constellation of symptoms including dizziness, undue fatigability, discomfort at the defect site, mental. Although this association led to the development of new terminology for the syndrome (“sinking skin flap syndrome”), numerous findings in the literature indicate the existence of SoT in patients without sinking skin flap morphology. sinking skin flap syndrome (aka, syndrome of the trephined) Basics: This usually occurs several months postoperatively. The syndrome has also been called the “syndrome of the sinking skin flap” by Yamaura and Makino. Need an account?. The sinking skin flap syndrome (SSFS) or syndrome of the trephined is a rare complication that occurs in approximately 10% of large craniectomies and tends to develop several weeks to several months after surgery. Sinking skin flap syndrome and vacuum suction drain may be the main risks of a postoperative venous congestion and stasis, which may result in diffuse cerebral swelling. The neurological status of the patient can occasionally be strongly related to posture. Teaching point: Sinking skin flap syndrome is a medical emergency that rarely complicates large craniectomy. It is defined as a neurological deterioration accompanied by a flat or concave. This results in displacement of the brain across various intracranial boundaries. 55 Sakamoto S, Eguchi K, Kiura Y, Arita K, Kurisu K CT perfusion imaging in the syndrome of the sinking skin flap before and after cranioplasty. An absent cranium allows for external compression via atmospheric pressure, causing alterations in cerebral blood flow, cerebral spinal fluid flow, and glucose. Expand. Hereby, we report for the first time that DC patients with LD can progress to SSFS or PH. Taste disorders. 3. Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported in trauma patients. (15%) had radiological SSF syndrome but no clinical symptoms except partial seizures in one. It occurs when atmospheric pressure exceeds intracranial pressure at the craniectomy defect. Introduction. 1. 2: (A – B) Coronal CT images confirmed the sinking skin flap on the left side of the cranium and showed concave deformity of the underlying brain. readdressed the issue of the ambiguous notion behind the ST. 1 It consists of a sunken skin above the bone defect with neurological symptoms such as severe headaches, mental changes, focal deficits, or seizures. “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. 39. Sinking skin flap syndrome is a delayed complication of a decompressive craniectomy. reported on cases of trephine syndrome, as characterized by severe headaches, dizziness, pain, adverse effects of cranial defects, and depressive symptoms that improved after cranioplasty. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients' head, diuresis and. Abstract. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. Complications following craniotomy are not uncommon and Sinking Skin Flap Syndrome (SSFS) constitutes a rare entity that may present after a large Decompressive Hemicraniectomy (DC) [ 1 ]. BACKGROUND Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. In a study of 108 patients performed back in 2008 who underwent decompressive crainectomy, syndrome of trephined was reported in 13% of patients between 28 and. This syndrome also associates various symptoms such as. 1. Crossref, Medline, Google ScholarSinking skin flap syndrome (SSFS) or “syndrome of the trephined” is a rare complication that can occur after decompressive craniectomy. Joseph V; Reilly P. Results. and seizure related to cerebral cortex distortion under the skin flap once cerebral edema subsides. Crossref, Medline, Google ScholarObjectives Syndrome of the Trephined (SoT) or sinking skin flap syndrome is characterised by neurological deterioration occurring after a delay post-craniectomy, with or without a significant postural component, that may improve with cranioplasty. The 2024 edition of ICD-10-CM M95. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a conclusive. ICU勉強会 担当：S先生. First, sinking flap syndrome (also called syndrome of trephined) is an underreported complication after decompressive craniectomy, its incidence remains unclear, and the symptoms of the syndrome are multifarious. Clin Neurol Neurosurg 2006;108(6):583–585. Paradoxical brain herniation, also known as sinking skin flap syndrome or syndrome of the trephined, is a rare and potentially fatal complication of decompressive craniectomy. Teaching point: Sinking skin flap syndrome is a medical emergency that rarely complicates large craniectomy. Sinking skin flap syndrome (SSFS) is a rare complication following large craniectomy and usually manifests as mental state decline, severe headache, seizures or focal deficits after a relatively stable and improved stage. Del Med J. As opposed to this, persistent brain herniation also occurs in patients after a decompressive craniectomy and a cerebrospinal fluid (CSF) drainage. 沈没皮膚フラップ症候群（SSFS）、またはトレフィン酸症の症候群は、頭蓋骨の大きな骨欠損の存在から生じる病的状態です。. The sinking skin flap syndrome (SSFS) is defined as a secondary neurological deterioration which cannot be attributed to the primary illness and which occurs in the presence of a sinking skin flap. 1. Sinking skin flap syndrome is defined as neurologic deficits with concave deformity and relaxation of the skin flap which tends to develop several weeks to months after large craniectomy [ 7 ]. Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. Sinking skin flap syndrome, or syndrome of trephined, seems as a DC-related complication in the first several weeks and months after DC. Introduction: The “Motor Trephine Syndrome (MTS)” also known as the “Sunken brain and Scalp Flap Syndrome” or the. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. Sinking skin flap syndrome (SSFS) or “syndrome of the trephined” is a rare complication that can occur after decompressive craniectomy. It occurs from several weeks to months after decompressive craniectomy (DC). Appointments Appointments. Introduction. The mechanism underlying syndromic onset is not entirely. Europe PMC is an archive of life sciences journal literature. Paradoxical brain herniation, also known as sinking skin flap syndrome or syndrome of the trephined, is a rare and potentially fatal complication of decompressive craniectomy. Patients with SSF syndrome had a smaller surface of craniectomy (76. INTRODUCTION. Bone defects of the skull are observed in various pathological conditions, including head trauma and conditions. × Close Log In. This phenomenon may result from CSF hypovolemia, atmospheric pressure gradient that may be aggravated by CSF diversion, dehydration, and position change 4 , 7) . The syndrome of the sinking skin flap was introduced to explain neurological deterioration after decompressive craniectomy 15). Four days after his cranioplasty, follow-up CT images showed reversal of the midline shift with no significant complications in the underlying brain . Alteration in normal anatomy and pathophysiology can result. ” In the presented case, these neurologic deficits may be a consequence of reduced cerebral blood flow 1 and a disturbed metabolism due to direct cortical compression of the sinking cranioplasty and the secondary diaschisis at different. 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. (f) One month after revision a sinking flap syndrome developed. Yet, no difference was found with regard to surgical revision, and sinking skin flap syndrome did not lead to earlier CP in our cohort. The syndrome has also been called the “syndrome of the sinking skin flap” by Yamaura and Makino. 2A). Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly. Disabling neurologic deficits, as well as the impairment of. Hakmi H, Joseph D K, Sohail A, Tessler L, Baltazar G, Stright A. [1] The sinking skin flap syndrome (SSFS), or. Syndrome of the trephined also called “sinking skin flap syndrome” is a rare and late complication of the craniectomy. 1,2 The SSF may progress to “paradoxical herniation. This results in displacement of the brain across various intracranial boundaries. However, several groups reported higher complication rates in early CP. some patients could (exhibit) neurological decline without concave skin flap . This condition involves sinking of the scalp on the decompressed side deep beyond the edges of the bone defect. After bone removal, the stretched scalp above the bone defect may sink due to the absence of underlying bone to support the atmospheric pressure. PDF. The sinking flap syndrome (SFS) is one of the complications of decompressive craniectomy (DC). In some cases, patients with SSFS are unable to undergo immediate. However, several groups reported higher complication rates in early CP. Commonly, it is associated with sinking of the skin near the bone-free area. The mechanism underlying syndromic onset is poorly understood. Sinking skin flap syndrome (SSFS) or "syndrome of the trephined" is a rare complication that can occur after decompressive craniectomy. A 61-year-old male was hospitalized with high fever and operative site swelling. Initial series of patients with this syndrome were small, to. 11 In that series, 86% of the patients (37 out of 43) presented long-term neurologic improvement after cranioplasty, although the inclusion. Nonetheless, full healing of the skin flap was evidentSinking Skin Flap Syndrome Published: September 08, 2017 43/48 contusion over right temporal lobe with patent basal cistern. 4–7 The mean onset of sinking skin flap syndrome is approximately 5 months. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. In the present case, sensorimotor paresis promptly reversed after cranioplastic repair and MR brain perfusion. The sinking skin flap syndrome may progress to "paradoxical herniation" as a consequence of the atmospheric pressure exceeding intracranial pressure and may eventually lead to coma and death 6). Infrequently, neurologic deteriorations accompanied by sunken scalp may occur after DC. 4). 1012047. 0%, p < 0. ・感染. (d) Flap re-suturing was then easily obtained. He had been continuously taking 75 mg of clopidogrel bisulfate daily after decompressive craniectomy for the acute cerebral infarction and discontinued the medication 7 days before cranioplasty. Sinking skin flap syndrome (SSFS) or "syndrome of the trephined" is a rare complication that can occur after decompressive craniectomy. Thus, there is growing evidence that the incidence of SoT might be underestimated because of a lack of. Log in with Facebook Log in with Google. c. Sinking Skin Flap Syndrome . 9). 2012. ・1997年Yamamuraらによって報告. Hence, an early cranioplasty can serve as a. We considered that the cause of brain edema and cerebral hemorrhage immediately after cranioplasty could be from reperfusion, the deterioration of autoregulation, SSFS, negative pressure by subgaleal drain, venous stasis, vascular damage because of. Sinking skin flap syndrome is a rare complication of decompressive craniectomy characterized by a sunken skin flap, neurological deterioration, and paradoxical herniation of the brain. or. The pressure gradient takes several weeks to months to develop [3]. The neurosurgery service subsequently. Sinking skin flap syndrome (SSFS) is a rare neurological complication in patients with traumatic haemorrhage, stroke or cerebral oedema who undergo decompressive craniectomy to relieve increased intracranial pressure. Three weeks later his flap had sunk in deeply and the skin was non-pinchable and he was noted to have headaches, vomiting and retching when he sat up. It appears in the weeks or months (3 months in average). The “syndrome of the trephined” or “sinking skin flap syndrome” is a rare complication of a craniectomy characterized by postoperative neurological deterioration caused by cortical dysfunction of the area below the craniotomy that improves after cranioplasty. Even less common is the development of SSFS following bone resorption after cranioplasty with exacerbation by. Korean J Neurotrauma. Sinking skin flap syndrome (SSFS) or paradoxical herniation (PH) is a rare complication and sporadically occurs in patients after DC. This condition involves sinking of the scalp on the decompressed side deep beyond the edges of the bone defect. 19 Syndrome of Trephine • Sinking skin flap syndrome. We then performed cranioplasty with a titanium mesh and omental flap on day 31. The sinking flap syndrome (SFS) is one of the complications of decompressive craniectomy (DC). The syndrome of the trephined was introduced in 1939 as a feeling of tenderness, discomfort, and insecurity located at the site of craniectomy. Although frequently presenting with aspecific symptoms, that may be underestimated, it can lead to severe and progressive neurological deterioration and, if left untreated, even to death. Syndrome of the trephined (ST) is a post-craniectomy complication. The Sinking Skin Flap Syndrome in Modern Literature. [] Although it is very rare, sinking skin flap syndrome may lead to paradoxical brain herniation, which is. Europe PMC is an archive of life sciences journal literature. 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. Sinking skin flap syndrome is a rare complication of decompressive craniectomy characterized by a sunken skin flap, neurological deterioration, and paradoxical herniation of the brain. The “Motor Trephine Syndrome (MTS)” also known as the “Sunken brain and Scalp Flap Syndrome” or the “Sinking Skin Flap Syndrome (SSFS)” or the “Syndrome of the trephined” is an unusual syndrome in which neurological deterioration occurs following removal of a large skull bone flap. The characteristic phenomenon would be described as “the syndrome of the sinking skin flap, ” considering that neurological deterioration may be due solely to effect of concave deformity of the skin flap upon the underlying. MTS is. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients’ head, diuresis and. symptoms and imaging findings that may raise concern/constitute the syndrome are acute postoperative deterioration after hemicraniectomy with or without temporal association with external ventricular drainage or lumbar puncture. In three cases, a pure muscle flap with any skin paddle was transferred (7%). See the case: Sinking skin flap syndrome. 127. Abstract. Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported in trauma patients. At the other polar extreme, external brain tamponade occurs when subgaleal fluid accumulates under pressure and 'pushes' on the brain across the craniectomy defect. Crossref, Medline, Google ScholarA diagnosis of syndrome of the sinking skin flap (SSSF) was considered. Cranioplasty was performed on the right side, however during the recovery phase the patient became obtunded, encephalopathic and bradycardic. Conclusions. "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. Upright computed tomography (CT) before cranioplasty showed a. 117 Corpus ID: 36217191; Reperfusion Injury after Autologous Cranioplasty in a Patient with Sinking Skin Flap Syndrome @article{Kwon2012ReperfusionIA, title={Reperfusion Injury after Autologous Cranioplasty in a Patient with Sinking Skin Flap Syndrome}, author={Sae Min Kwon and Jin Hwan. The sinking skin flap syndrome may progress to "paradoxical herniation" as a consequence of the atmospheric pressure exceeding intracranial pressure and may eventually lead to coma and death 6). The syndrome of the “trephined” or the “sinking skin flap” (SSF) syndrome is a rare complication after a large skull bone defect. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a. Sinking skin flap syndrome is typically a late post-craniectomy complication, most often occurring between 1 month and 1 year after surgery. A diagnosis of syndrome of the trephined or “sinking skin flap syndrome were considered in them, and all of them improved after cranioplasty. Disabling neurologic deficits, as well as the impairment of. In patients where the skin may not be enough to cover the CP, due to an SSFS or skin. Even less common is the development of SSFS. A late complication following craniectomy is the “sinking” of the skin flap over the surgical site, known as the “Sunken brain and Scalp Flap Syndrome”(SSFS) or “Motor Trephine Syndrome” (MTS) (Figure (Figure2A). 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 may result in subfalcine and/or transtentorial herniation. Introduction. It is defined as a neurological deterioration accompanied by a flat or concave. Postoperatively, the patient was treated with hydration and bed rest for 3 days. "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. Intracranial Herniation Syndromes. Sakamoto S, Eguchi K, Kiura Y, Arita K, Kurisu K (2006). CT perfusion imaging in the syndrome of the sinking skin flap before and after cranioplasty. should be considered in the differential. Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported in trauma patients. The mechanism underlying syndromic onset is poorly understood. The prevalence and characteristics of SSF syndrome after hemicraniectomy for malignant infarction of the. However, SSFS is reversible after cranioplasty [3], but infectious complications must be avoided after the procedure [4]. After that, sinking skin flap syndrome has been reported fairly in the literature. MTS is. However, it may result in sinking skin flap syndrome (SSFS) in some patients, for which cranioplasty is the only treatment option. A 77-year-old male patient with an acute subdural hematoma was treated using a hemicraniectomy. The syndrome encompasses a wide spectrum of. The radiologist must be vigilant regarding the appearance of. Thieme E-Books & E-Journals. Postoperatively, strict follow-up and early cranioplasty are warranted . 8) In 1977, Yamaura et al. ・外減圧後の合併症. The neuro-intensive care team should be prepared to diagnose and treat a spectrum of decompressive craniectomy complications including: cerebral contusions, infections, seizures, intra- and extra-axial hemorrhages and fluid collections, sinking skin flap syndrome or syndrome of the trephined, paradoxical herniation, and external brain. Among many, sinking flap syndrome or syndrome of the trephined or paradoxical herniation of brain is frequently underestimated. Search terms “syndrome of the trephined” and “sunken flap syndrome” were applied to PubMed to identify primary studies through October 2021. The prevalence and characteristics of SSF syndrome after hemicraniectomy for malignant infarction of the. We report a case of syndrome of the trephined that. . What is a sunken brain? Abstract. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. It results from the pressure difference between the atmospheric pressure and the intracranial pressure causing the brain to shift inward at the craniectomy site. This report intends to describe an uncommon case of a. 5 The development of symptoms is often insidious, but may be acute, and may be exacerbated. Patient concerns: A 74-year-old man presented with traumatic subdural hematoma and underwent decompressive craniectomy. This phenomenon may result from CSF hypovolemia, atmospheric pressure gradient that may be aggravated by CSF diversion, dehydration, and position change1,4. Right MCA Infarct 4. Disabling neurologic. Sinking skin flap syndrome, resulting from decompressive craniectomy, is defined as a series of neurologic symptoms with skin depression at the site of cranial defect. Advanced searchAbstract. Sinking skin flap syndrome is defined as a series of neurologic symptoms with the skin depression at the site of cranial defect, which develop several weeks to months after large external cerebral. Sinking skin flap syndrome (SSFS) is a condition unique to patients who have undergone craniectomy [2]. ・1997年Yamamuraらによって報告. TLDR. 1007/s00234-016-1651-8. This phenomenon known as sinking skin flap syndrome or syndrome of trephined is a retroactive diagnosis rendered when a patient has reversal of postcraniectomy symptoms (described below) following cranioplasty. Clin Neurol Neurosurg 2006;108(6):583–585. ” Syndrome of the trephined had an overall frequency of 10 % (43/425) following DC [25, 27, 38, 101, 103]. Sinking Skin Flap Syndrome: Cause of Secondary Neurological Deterioration. (38%). The "sinking skin flap syndrome" (SSFS) is characterized by neurological symptoms (headache, epileptic seizures, vertigo, dysesthesias, or paresis) following extensive decompressive craniectomy which improve after cranioplasty. “Sinking skin flap syndrome” (SSFS) is defined as a secondary neurological deterioration in the presence of a sinking skin flap in patients with large craniectomies. In 1939, Grant et al. Upright computed tomography (CT) before cranioplasty. 5 The development of symptoms is often insidious, but may be acute, and may be exacerbated by dehydration and patient positioning. 7.