Sinking skin flap syndrome (SSFS) - clinical spectrum and impact on rehabilitation

"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. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a conclusive concept, integrating all contributing factors, is still lacking. Knowledge about the true incidence of this phenomenon is rare. This case series describes the clinical spectrum of SSFS. Since it is to be expected that decompressive craniectomies will be carried out more often in the future, SSFS will become increasingly important. Cranioplasty leads to clinical improvement in the majority of cases and should therefore be performed early in the course in order to avoid secondary neurological deterioration. Cranioplasty is thus a therapeutic and more than merely a cosmetic procedure.