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Sinking Skin Flap Syndrome After Decompressive Craniectomy: A Case Report
Nicholas Fawley1, Chiedozie Udeh
1From the Center for Critical Care, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
A&A Practice
|May 15, 2018
Summary
Sinking skin flap syndrome, a rare decompressive craniectomy complication, causes neurological decline due to atmospheric pressure on the brain. Prompt diagnosis and cranioplasty are crucial for recovery and preventing severe outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Pathophysiology
Background:
- Sinking skin flap syndrome is a rare complication following decompressive craniectomy.
- It presents with a sunken skin flap, neurological deterioration, and paradoxical brain herniation.
- The absence of the cranium leads to external atmospheric pressure causing altered cerebral blood flow, CSF dynamics, and metabolism.
Observation:
- The absence of the cranium leads to external compression by atmospheric pressure.
- This compression alters cerebral blood flow, cerebrospinal fluid dynamics, and brain glucose metabolism.
Findings:
- The case report details a patient experiencing early-onset, variable neurological symptoms.
- Imaging confirmed the diagnosis, leading to therapeutic intervention with cranioplasty.
Implications:
- Early recognition and diagnosis of sinking skin flap syndrome are critical.
- Timely cranioplasty can prevent potentially devastating neurological sequelae.
- This condition is underreported, highlighting the need for increased awareness.
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