Outcome of Early Cranioplasty in Trephine Syndrome or Paradoxical Brain Herniation: A Case Report and Literature Review

Abstract

Sinking skin flap syndrome (SSFS) is a rare complication observed in patients after craniectomy. The intracranial pressure is decreased after craniectomy, resulting in some conditions. These include mental change, focal deficits, headache, seizures, and dysautonomia. Cranioplasty is the most commonly used treatment method for SSFS. Here, the case of a patient is presented with symptoms, including sudden loss of consciousness, aphasia, and right-side weakness. A computed tomography (CT) scan revealed hemorrhagic conversion of parietotemporal infarct with midline shift. A decompressive craniectomy was performed, and the patient developed SSFS later. Subsequently, the patient underwent cranioplasty and showed improvements in neurological deficits. SSFS is rare; only a few cases have been reported in the literature.

Keywords: cranioplasty; decompressive craniectomy; global aphasia; seizures; sinking skin flap syndrome.

Figure 1. Initial presentation CT brain, with the arrow representing hemorrhagic area.

Figure 2. CT brain post-operatively, with the arrow representing post-craniectomy changes, as mentioned in the text.

Figure 3. MRI T2-weighted images showing post-op changes, with the arrow pointing towards the hematoma.

Figure 4. CT brain, with the arrow pointing towards hygroma.

Figure 5. Post-cranioplasty CT brain, with the arrow representing distinct improvements of the lesion, and a decreased midline shift in the image is also appreciable.