Sinking Skin Flap Syndrome After Decompressive Craniectomy: A Case Report
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Updated: Feb 10, 2026

Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Nicholas Fawley1, Chiedozie Udeh
1From the Center for Critical Care, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Abstract:
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. An absent cranium allows for external compression via atmospheric pressure, causing alterations in cerebral blood flow, cerebral spinal fluid flow, and glucose metabolism, which ultimately leads to cortical dysfunction. This case report describes a patient with relatively early onset of variable neurological symptoms and imaging correlation, leading to a diagnosis and definitive therapeutic intervention with cranioplasty. Prompt recognition is critical to avoid potentially devastating neurological outcomes in this rare, but underreported condition.
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