Syndrome of the trephined following bifrontal decompressive craniectomy: implications for rehabilitation

Abstract

Objective: The syndrome of the trephined is a rare complication observed following a unilateral decompressive craniectomy for traumatic brain injury. What has not been previously reported is the occurrence of this complication following a bifrontal procedure. The objective of this study was to present two clinical cases that serve to highlight this condition.

Design: A case study of two patients who had had a bifrontal decompressive craniectomy for severe traumatic brain injury.

Method: A review was undertaken detailing the clinical course of the two patients.

Results: Both cases were young males. They had initially made significant improvement in their functional and cognitive performance whilst undergoing rehabilitation. However, after some months they demonstrated marked deterioration. Immediately following cranioplasty they showed considerable clinical improvement.

Conclusion: If the use of bifrontal decompressive craniectomies continues to increase it is important that those involved in the rehabilitation process are familiar with this rare condition. Early recognition is important so that patients can receive timely intervention and it also avoids valuable health resources being allocated to patients who cannot receive maximal benefit.