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[A case of brain herniation due to delayed bone flap sinking]
Ryogo Anei1, Genki Uemori, Ryosuke Orimoto
1Department of Neurosurgery, Asahikawa Medical College, Hokkaido, Japan.
No Shinkei Geka. Neurological Surgery
|November 3, 2010
Summary
Delayed sinking flap syndrome can cause severe neurological issues years after surgery. This case highlights the importance of securing bone flaps during cranial closure to prevent late complications.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Sinking flap syndrome, characterized by skin flap depression after decompressive craniotomy, can impair brain function.
- While typically observed earlier, delayed sinking of the entire bone flap inducing neurological deficits is rarely reported.
Observation:
- A 59-year-old male presented with limb paresis 15 years post-craniotomy for a ruptured internal carotid aneurysm.
- Imaging revealed sinking of the entire bone flap and contralateral uncal herniation.
Findings:
- The patient's neurological symptoms, including paresis, were attributed to the delayed sinking of the entire bone flap.
- Surgical intervention involving uncal resection and bone flap fixation led to symptom improvement.
Implications:
- This case underscores the critical importance of robust bone flap fixation during initial cranial closure.
- Adequate fixation may prevent long-term complications such as delayed sinking flap syndrome and associated neurological deficits.
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