1 a and b). Four days after his cranioplasty, follow-up CT images showed reversal of the midline shift with no significant complications in the underlying brain . PDF. The syndrome of the sunken skin flap: a neglected potentially reversible phenomenon affecting recovery after decompressive craniotomy. 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. With increasing numbers. The search yielded 19 articles with a total of 26 patients. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a. It results from the pressure difference between the atmospheric pressure and the intracranial pressure causing the brain to shift inward at the craniectomy site. "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. Enter the email address you signed up with and we'll email you a reset link. Following an inner ellipse of the previous DC-surgery scar could contribute in most cases to the preservation of the vascular perfusion even if an incision outside of the ellipse might be needed in certain settings such as sinking skin flap syndrome (SSFS). 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. 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. The term sinking skin flap syndrome assumes that the herniation in this setting results from the combined effects of brain gravity and CSF depletion in patients who have undergone decompressive craniectomy [10, 11]. g. Exposed to a higher. y community. If you would like to make an appointment with an expert in the Reconstructive Craniofacial. It results from the pressure difference between the atmospheric pressure and the intracranial pressure causing the brain to shift inward at the craniectomy site. Primary hemorrhages result from direct trauma, hypertension, coagulopathy, whereas secondary hemorrhages may result from descending transtentorial herniation from diverse etiologies. Sakamoto S, Eguchi K, Kiura Y, Arita K, Kurisu K (2006). Syndrome of the Trephined (SOT) or sinking skin flap syndrome is a known but rare complication following large craniectomy. We studied the clinical characteristics associated with complications in patients undergoing CP, with. Without early identification and. Sinking skin flap syndrome, also known as “syndrome of the trephined,” is an uncommon complication after decompressive craniectomy. 5 The development of symptoms is often insidious, but may be acute, and may be exacerbated. Therefore, in a patient with decompressive craniectomy, lumbar drainage or shunt surgery carries a risk to cause sinking skin flap syndrome (SSFS) or trephined syndrome, progressing to paradoxical. Sinking skin flap syndrome (SSFS) or "syndrome of the trephined" is a rare complication that can occur after decompressive craniectomy. 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 ]. There were no language restrictions. 8) In 1977, Yamaura et al. Background. 2015. DOI: 10. A diagnosis of syndrome of the trephined or “sinking skin flap syndrome were considered in them, and all of them improved after cranioplasty. 0%, p < 0. 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. “Trephined syndrome” or “sinking skin flap syndrome” is a complication that causes neurological deterioration during the post-craniectomy period . Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction. The neuro-intensive care team should be prepared to diagnose. 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 in patients with large craniectomies. 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). Als Sinking-Skin-Flap-Syndrom (Syndrom des sinkenden Hautlappens, SSFS) wird die Symptomkombination aus Einsinken des Hautlappens und des darunter liegenden Hirnparenchyms im Bereich einer großen Kraniektomie und einer sekundären neurologischen Verschlechterung, unabhängig von der primären Erkrankung, bezeichnet. Sinking Skin Flap Syndrome: Cause of Secondary Neurological Deterioration. He was diagnosed with sinking skin flap syndrome consistent with altered mental status and a sunken skin flap with increased midline shift. ・感染. 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). Abstract. Atmospheric pressure and gravity overwhelm intracranial pressure, leading to the depression of the scalp flap. Although frequently presenting with aspecific symptoms, that may be. These 2 syndromes illustrate the paradigm shift of the indications for cranioplasty, which have evolved from cosmetic. In 1939, Grant et al. 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. The mechanism underlying syndromic onset is poorly understood. The neurosurgery service subsequently. The sinking skin flap syndrome, also known as the syndrome of the trephined or the trephination syndrome, occurs in patients who have undergone a decompressive craniectomy. A 77-year-old male patient with an acute subdural hematoma was. Europe PMC is an archive of life sciences journal literature. After removing the lumbar drainage, cerebrospinal fluid leakage occurred. Results. Alteration in normal anatomy and pathophysiology can result in wide variety of symptoms including altered mental status, hemodynamic instability, and dysautonomias. A 56-year-old man developed sinking skin flap syndrome (SSFS) due to paradoxical uncal herniation during treatment with furosemide for congestive heart failure (CHF). In 1939, Grant et al. Disabling neurologic. Sinking skin flap syndrome is a catastrophic delayed complication in patients who underwent craniectomy for various reasons. 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. 2020; 2020 (06):a172. [] Although it is very rare, sinking skin flap syndrome may lead to paradoxical brain herniation, which is. Bone defects of the skull are observed in various pathological conditions, including head trauma and conditions. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. In three cases, a pure muscle flap with any skin paddle was transferred (7%). This report intends to describe an uncommon case of a. Even less common is the development of SSFS following bone resorption after cranioplasty with exacerbation by a ventriculoperitoneal (VP) shunt. 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. Remember me on this computer. 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. Even less common is the development of SSFS following bone resorption after. Syndrome of the trephined also called “sinking skin flap syndrome” is a rare and late complication of the craniectomy. 「外減圧後の合併症」. 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. 1 It consists of a sunken skin above the bone defect with neurological symptoms such as severe headaches, mental changes, focal deficits, or seizures. 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. 8 3 Rotation Flap Skin Flaps Essential Surgical Skills White…Sinking skin flap syndrome is rare phenomenon that occurs in patients with large craniectomies. 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. This phenomenon may result from CSF hypovolemia, atmospheric pressure gradient that may be aggravated by CSF diversion, dehydration, and position change 4 , 7) . It results from an intracerebral hypotension and requires the replacement of the cranial flap. “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. Retrospective analysis found that those patients with sinking skin flap syndrome had significantly smaller surface craniectomy, tended to be older in age, and had a larger infarct volume. Management is largely conservative. ・Sinking Skin Flap Syndrome（SSFS）. [1] The sinking skin flap syndrome (SSFS), or. 2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The man had car accident and developed left hemispheric subdural haematoma, multiple pelvic fractures and pulmonary contusions that led to admission to the trauma. 4 vs 9. In a recent work concerning 43 patients admitted for SSFS after DC, Di Rienzo et al. Hallmark of SSFS is the sinking of the scalp to a plane lower than the edges of the skull defect in the setting of neurological. Introduction: The sinking skin flap syndrome is a complication of decompressive craniectomies. Isago T, Nozaki M, Kikuchi Y, et al. 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. Sinking skin flap syndrome (or Syndrome of the trephined): A review 2015 Jun;29 (3):314-8. However, several groups reported higher complication rates in early CP. 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. • 22/9/13 - moderate size infarct , thrombolysed with IV tPA 5. 7. 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 in patients with large craniectomies. (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). This may result in subfalcine and/or transtentorial herniation. This syndrome comprises a wide spectrum of neurological symptoms including delay in neurological progression, motor symptoms, cognitive decline, impaired vigilance, and headaches [ 26 ]. Clinical presentation May range from asymptomatic or mono symptomat. Furthermore, restoring patients' functional outcome and. ・感染. 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 brain tissue. Sinking skin flap syndrome (SSFS) is a complication among long-term survivors of stroke or traumatic brain injury treated by decompressive craniectomy. However, several groups reported higher complication rates in early CP. 1 A–D). ST is also known as "sinking skin flap syndrome" and typically occurs in the weeks to months following operation. The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. A 20-year-old male. Semantic Scholar extracted view of "The problem of the “sinking skin‐flap syndrome” in cranioplasty" by S. he syndrome of the “trephined” or the “sinking skin flap” (SSF) syndrome is a rare complication after a large skull bone defect. 5 The development of symptoms is often insidious, but may be acute, and may be exacerbated. 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. We report a unique case presenting with these complications immediately after decompressive craniectomy for severe traumatic brain injury. Spontaneous bone healing occurred in all the survived cases and completed several months after surgery due to the difference of age (Fig. Sinking skin flap syndrome is rare phenomenon that occurs in patients with large craniectomies. View full size version of Sinking skin flap syndrome. This usually. It is defined as a neurological deterioration accompanied by a flat or concave. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. Eventually, in some cases, a significant difference between atmospheric and intra cranial. It is defined as a neurological deterioration accompanied by a flat or concave. marked concavity at the craniotomy site accompanied by subfalcine and/or transtentorial herniationSinking 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 (ST), is characterized by the development of new neurological symptoms following decompressive craniectomy (e. 3. It occurs from several weeks to months after decompressive craniectomy (DC). 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. J Surg Case Rep. The syndrome of the trephined (ST), also known as the “sinking skin flap syndrome”, is a disorder of delayed neurological deterioration . drain, venous stasis, vascular damage following restoration of midline shift, and allergic reaction. The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. The prevalence and characteristics of SSF syndrome after hemicraniectomy for malignant infarction of the. 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. Without early identification and. Sinking skin flap syndrome (SSFS) is a rare complication of decompressive craniectomy (DC) and causes a wide range of neurological deficits. The sinking flap syndrome (SFS) is one of the complications of decompressive craniectomy (DC). Gadde, J, Dross, P, Spina, M. The sinking flap syndrome (SFS) is one of the complications of decompressive craniectomy (DC). ” In the 1970s, Yamaura and Makino used the term “syndrome of the sinking scalp flap” to describe the objective focal neurological deficits that can occur in patients with a hemicraniectomy defect and. 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 authors performed a systematic review of the literature on SoT with a focus on reconstructive implications. We present a. Sinking skin flap syndrome, or syndrome of trephined, seems as a DC-related complication in the first several weeks and months after DC. Europe PMC is an archive of life sciences journal literature. 2010; 41:560–562 Link Google Scholar; 23. The average reported craniectomy is 88. . No problems occurred during the operation, but cerebral edema and hemorrhage were recognized on immediate postoperative computed tomography. Patient concerns: A 74-year-old man presented with traumatic subdural hematoma and underwent decompressive craniectomy. We report our experience in a consecutive series of 43 patients diagnosed with SFS and propose a classification. The sinking skin flap syndrome is a set of neurological manifestations occurring weeks or even months after a large craniectomy performed for different reasons: severe head trauma as in the case. TLDR. 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. The syndrome has also been called the “syndrome of the sinking skin flap” by Yamaura and Makino. Appointments Appointments. 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. Introduction: The “Motor Trephine Syndrome (MTS)” also known as the “Sunken brain and Scalp Flap Syndrome” or the. Disabling neurologic deficits, as well as the impairment of. Sinking skin flap syndrome (SSFS) or "syndrome of the trephined" is a rare complication that can occur after decompressive craniectomy. It was first described by Grant and Norcross in 1939 as a constellation of symptoms including dizziness, undue fatigability, discomfort at the defect. We also evaluated the risk factors for the incidence of SSFS in DC patients with LD. Abstract. In this case report,. 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. The syndrome has also been called the “syndrome of the sinking skin flap” by Yamaura and Makino. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients’ head, diuresis and. Background: Bone defects of the skull are observed in various pathological conditions, including head trauma and conditions requiring surgery of the skull. 1. The neurological status of the patient can occasionally be strongly related to posture. Furthermore, SoT is often associated with a sinking skin flap morphology, a radiologic and clinical sign . 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. 3. Skip to search form Skip to main content Skip to account menu. Flap Syndrome(플랩 증후군)란 무엇입니까? Flap Syndrome 플랩 증후군 - All patients had stroke-related complications; one (6%) patient developed cerebrospinal fluid leak, 3 (17%) had sunken skin flap syndrome and wound infection each, and 2 (11%) developed epidural hematoma. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have. Syndrome of the trephined (ST) is a post-craniectomy complication. The neurological status of the patient can occasionally be strongly related to posture. or reset password. Teaching point: Sinking skin flap syndrome is a medical emergency that rarely complicates large craniectomy. Introduction. Complications following craniotomy are not uncommon and Sinking Skin Flap Syndrome (SSFS) constitutes a rare entity that may present after a large. edu no longer supports Internet Explorer. 2. One hypothesis has been that atrophy of the infarcted tissue leads to a decrease in the intracranial volume and subsequently a decrease in intracranial. Cranioplasty is an in evitable operation conducted after decompressive craniectomy (DC). 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. and seizure related to cerebral cortex distortion under the skin flap once cerebral edema subsides. 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. The symptoms and signs improve after cranioplasty. We present a patient with sinking skin flap syndrome that underwent such a procedure and subsequently experienced immediate postoperative ascending transtentorial herniation and intracranial hemorrhage remote from the surgical site. INTRODUCTION. At the other polar extreme, external brain tamponade occurs when subgaleal fluid accumulates under pressure and 'pushes' on the brain across the craniectomy defect. Although many theories have been put forward regarding development of SSFS, but commonly it is thought that there are. 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) or “syndrome of the trephined” is an uncommon occurrence classically associated with decompressive craniectomy prior to cranioplasty [1, 2]. the syndrome’s characteristics. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain. Neurol Med Chir 17: 43-53. Introduction: 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. This can present with either nonspecific symptoms. The syndrome of the sinking skin flap was introduced to explain neurological deterioration after decompressive craniectomy 15). The pressure gradient takes several weeks to months to develop [3]. PMID: 26906112. Grantham coined the term “the post traumatic syndrome” to describe similar subjective symptoms to that of “syndrome of the trephined. The sinking bone flap syndrome may present initially with protean manifestations that may be related to changes in posture and may not show up on conventional imaging done in a supine posture. The 2024 edition of ICD-10-CM M95. SUNKEN SKIN FLAP SYNDROME : a case presentation and review Dr Bipin Bhimani Well Care Hospital Rajkot 2. The problem was considered to have been asymptomatic sinking skin flap syndrome (SSFS). It seems logical that longer times-to-cranioplasty would promote the neurologic compromise associated with the syndrome of the sinking skin flap [4, 11, 13, 14]. Introduction . Sinking skin flap syndrome is a rare and potentially fatal complication of a decompressive craniectomy. A 61-year-old male was. In patients where the skin may not be enough to cover the CP, due to an SSFS or skin. See the case: Sinking skin flap syndrome. In addition to the external compressive effects on the brain which result from atmospheric pressure and gravitational forces, secondary effects including ischemia can occur as a result of altered cerebral perfusion. 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. Despite treatment with Trendelenburg positioning and appropriate fluid management, the patient continued to decline, and an epidural blood patch was requested for treatment. Intensive Care Med. 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. Di Rienzo A, Colasanti R, Gladi M. Decompressive craniotomy. The neurological status of the patient can occasionally be strongly related to posture. The syndrome of the “trephined” or the “sinking skin flap” (SSF) syndrome is a rare complication after a large skull bone defect. 5 The development of symptoms is often insidious, but may be acute, and may be exacerbated by dehydration and patient positioning. "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 flap syndrome: a case of improved cerebral blood flow after cranioplasty. Syndrome of the trephined (ST) refers to the rare, reversible event of neurological deterioration following craniectomy. 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 in patients with large craniectomies. Although it is very rare, sinking skin flap syndrome may lead to paradoxical brain. The prevalence and characteristics of SSF syndrome after hemicraniectomy for malignant infarction of the middle cerebral. ・SSFSとは？. Cranioplasty is mostly required to treat the sinking skin flap syndrome to achieve further neurological improvement 1). It should be suspected in all patients who had skull surgery and present with new onset neurological deterioration and dysautonomic symptoms. ”. Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported. Although her general condition stabilized within 7 months after the injury, the skin of the bilateral temporal regions was markedly depressed due to large bone defects. 001). Sinking skin flap syndrome is a rare and potentially fatal complication of a decompressive craniectomy. However, SSFS is reversible after cranioplasty [3], but infectious complications must be avoided after the procedure [4]. Therefore, the scalp contraction may not. Sinking Skin Flap Syndrome . We then performed cranioplasty with a titanium mesh and omental flap on day 31. Also known by other names such as syndrome of the “trephined,” it consists of sunken skin above the bone defect along with neurological. (38%). The prevalence and characteristics of SSF syndrome after hemicraniectomy for malignant infarction of the. 8) In 1977, Yamaura et al. Sinking skin flap syndrome, often called as the “syndrome of trephined,” is a rare complication after a large craniectomy. 11 In that series, 86% of the patients (37 out of 43) presented long-term neurologic improvement after cranioplasty, although the inclusion. 1: (A – C) Axial CT images showed sinking skin flap on the left side of the cranium, characterized by the depressed meningocele complex at the craniectomy site. Krupp et al. Edema continued to progress, but edema and. Right MCA Infarct 4. . The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. Taste disorders. Europe PMC is an archive of life sciences journal literature. Syndrome of the trephined also called “sinking skin flap syndrome” is a rare and late complication of the craniectomy. Here, we demonstrate two cases of SSFS to emphasize the importance of timely diagnosis to avoid lethal sequelae of this phenomenon if not detected. Disabling neurologic deficits, as well as the impairment of. Complications following craniotomy are not uncommon and Sinking Skin Flap Syndrome (SSFS) constitutes a rare entity that may present after a large Decompressive Craniectomy. DOI: 10. Clin Neurol Neurosurg 2006;108(6):583–585. It consists of a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. A patient of sinking brain and skin flap syndrome. This condition involves sinking of the scalp on the decompressed side deep beyond the edges of the bone defect. In the two cases presented here, however, large cranial defects after DC resulted in a sunken scalp with neurologic deterioration. 4. 127. Clin Neurol Neurosurg 108: 583-585. A 61-year-old male was. Patients with the classical “Motor trephine syndrome/ Sinking skin flap syndrome” following large craniectomy defects, may hugely benefit from an early cranioplasty procedure, with a reversal of features of this syndrome and early recovery of their neurological and cognitive functions. "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. The prevalence and characteristics of SSF syndrome after hemicraniectomy for malignant infarction of the middle cerebral. 2006;32(10):1668–1669. Hallmark of SSFS is the sinking of the scalp to a plane lower than the edges of the skull defect in the setting. A 77-year-old male patient with an acute. Search 214,909,616 papers from. " Non-English-language and duplicate articles were eliminated. severe headache, tinnitus, dizziness, undue fatigability or vague discomfort at the site of the bone defect, a feeling of apprehension and insecurity, mental. 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. 1 Ashayeri et al. We used the following search terms: ‘trephined syndrome’, ‘syndrome of the trephined’, ‘Sinking skin flap’, and ‘sinking skin flap syndrome’. Therefore, it is important to. Background: Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. 2 became effective on October 1, 2023. 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 need for cranioplasty. 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. CT perfusion imaging in the syndrome of the sinking skin flap before and after cranioplasty. ・Sinking Skin Flap Syndrome（SSFS）. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. Cranioplasty is mostly required to treat the sinking skin flap syndrome to achieve further neurological improvement 1). It results from an intracerebral hypotension and requires the replacement of the cranial flap. It is characterized by the appearance of new neurological symptoms following the craniectomy, which are relieved after cranioplasty. Follow-up. (f) One month after revision a sinking flap syndrome developed. or. "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. 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. 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. 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 in patients with large craniectomies. It consists of a sunken scalp above the bone defect with neurological symptoms. Atmospheric pressure and gravity overwhelm. Suzuki N, Suzuki S, & Iwabuchi T (1993). 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. ”. 9). In some cases, patients with SSFS are unable to undergo immediate. 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). AU Sarov M, Guichard JP, Chibarro S. Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. Sinking skin flap syndrome (SSFS) is a condition unique to patients who have undergone craniectomy [2]. A patient with a history of traumatic brain injury, status post bilateral craniectomies is admitted for skull reconstruction due to bilateral frontoparietal cranial defects. Europe PMC is an archive of life sciences journal literature. On determining that the subgaleal drain was the responsible cause, it was immediate removed, and the patient had. In addition to the cosmetic and protective roles, cranioplasty also has a definite therapeutic role by reversing the sensorimotor deficits and neurological deterioration that often accompanies large cranial defects, a condition commonly referred to as the ‘Motor Trephine Syndrome’ (MTS) or ‘Sinking Skin Flap syndrome’(SSFS) . Infrequently, neurologic deteriorations accompanied by sunken scalp may occur after DC. It occurs from several weeks to months after decompressive craniectomy (DC). 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. If the defect is closed by a prosthetic covering then it is known as a cranioplasty. 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, resulting from decompressive craniectomy, is defined as a series of neurologic symptoms with skin depression at the site of cranial defect. Although it is very rare, sinking skin flap syndrome may lead to paradoxical brain herniation. Introduction. 1,2 The SSF may Introduction. 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. We also evaluated the risk factors for the incidence of SSFS in DC patients with LD. The patient then underwent cranioplasty using an autologous bone graft. Knowing that the mechanism of SSSF has been speculated to be the result of the. Europe PMC is an archive of life sciences journal literature. In our study, patients with big cranial defects after decompressive hemicraniectomy and altered consciousness who underwent cranioplasty at <7 weeks or at 7–12 weeks fared. 2012 Oct;8(2):149-152. 1012047. The shrinkage and displacement of the brain structure is caused by the differences in intracranial pressure and exter- nal atmospheric pressure. The physiopathology of ST or SSFS may involve a number of factors. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients’ head, diuresis and. The sinking skin flap syndrome is a set of neurological manifestations occurring weeks or even months after a large craniectomy performed for different reasons: severe head trauma as in the case. The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. Sinking skin flap syndrome is defined by a series of neurological symptoms with skin depression at the site of cranial defect. The syndrome of the trephined was introduced in 1939 as a feeling of tenderness, discomfort, and insecurity located at the site of craniectomy. Syndrome of the Trephined . Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a. TLDR. Although the entity is widely reported, the literature mostly consists of case reports. The syndrome of the sinking skin flap was introduced to explain neurological deterioration after decompressive craniectomy3. We report such a rare case in 38-year-old man who underwent right-sided. "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. 198. The main trouble in. craniotomy in which the bone flap is re-attached to the surgical defect) 1. [ 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 Sinking Skin Flap Syndrome in Modern Literature. Clin Neurol Neurosurg 2006; 108L 583–85 [Google Scholar] 3. It is defined as a neurological deterioration accompanied by a flat or concave. The pathophysiology of this phenomenon is not completely clear, but is felt to be related to the conversion of a closed system to an open system. Disabling neurologic deficits, as well as the impairment of. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a. ・SSFSとは？. Background: Sinking skin flap syndrome or paradoxical brain herniation is an uncommon neurosurgical complication, which usually occurs in the chronic phase after decompressive craniectomy. Among the long-term surviving patients, none reported symptoms compatible with the syndrome of the sinking skin flap. c. Introduction. 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. The sinking skin flap syndrome (SSFS) is a rare complication after a large craniectomy. Though autologous bone. 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. Sinking skin flap syndrome (SSFS) is a condition unique to patients who have undergone craniectomy [2]. Search life-sciences literature (43,080,284 articles, preprints and more) Search. Abstract. It is of relevance not only due to its frequency, it is often underdiagnosed, but also because of the possibility. 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. This usually. A 77-year-old male patient with an acute subdural hematoma was treated using a hemicraniectomy. 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. 2017. Abstract. ” 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. Trephine syndrome, also known as the sinking skin flap syndrome, is a relatively late complication in post-craniectomy patients. BACKGROUND Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. Clinical and radiological features (DC diameter, shape of craniectomy. ・広範な外減圧術後の稀な合併症. It consists of a sunken scalp. Sinking skin flap syndrome (SSFS) or “syndrome of the trephined” is an uncommon occurrence classically associated with decompressive craniectomy prior to cranioplasty [ 1, 2 ]. some patients could (exhibit) neurological decline without concave skin flap .