External Postoperative Skull Prosthesis (ExO-Skull) for Syndrome of the Trephined After Decompressive Craniectomy:...

Decompressive craniectomy (DC) is a life-saving surgery in which a large skull flap is removed to reduce intracranial pressures. Cranioplasty, surgery to reconstruct the skull, is most safely performed 3 to 6 months after DC. While waiting for definitive cranioplasty, as many as 65% of patients living with the resultant skull defect experience new and worsened neurological symptoms that improve only after cranioplasty, a condition known as sunken flap syndrome (SFS). Studies show that SFS patients' regulation of intracranial pressure and blood flow is altered due to exposure of the intracranial space to atmospheric pressure. Here, the authors report the first-in-man use of the external postoperative skull prosthesis (ExO-Skull), a custom 3-D printed external cranial prosthesis to prevent SFS after DC. One post-DC patient treated with ExO-Skull made a complete neurological recovery before cranioplasty without adverse events. Another patient with active SFS made neurological improvement after only 2 hours of ExO-Skull application.