Neurological susceptibility to a skull defect.

Area of Science:

• Neurosurgery
• Neurology

Background:

• Decompressive craniectomy is used for neurological emergencies but has complications.
• A less-recognized complication is neurological dysfunction from brain distortion after bone flap removal and subsequent swelling reduction.

Purpose of the Study:

• To review literature on clinical features of neurological dysfunction in patients with large skull defects.
• To outline the proposed pathophysiology of these manifestations.
• To highlight implications for patient rehabilitation.

Main Methods:

• A literature search was conducted in the MEDLINE database from 1966 to June 2012.
• Keywords included: Hemicraniectomy, decompressive craniectomy, complications, syndrome of the trephined, syndrome of the sinking scalp flap, and motor trephined syndrome.
• Bibliographies of retrieved reports were searched for additional references.

Main Results:

• Various terms describe neurological signs/symptoms in patients with skull defects, including syndrome of the trephined, posttraumatic syndrome, syndrome of the sinking scalp flap, and motor trephined syndrome.
• Significant overlap exists between these described conditions and individual patient presentations.

Conclusions:

• Certain patients are particularly susceptible to large skull defects.
• The term "Neurological Susceptibility to a Skull Defect" (NSSD) is proposed as an umbrella term for neurological changes linked to absent cranial coverage.