Sinking Skin Flap Syndrome/Syndrome of trephinad


Sinking Skin Flap Syndrome/Sydrome of trephinad

  • History of previous cranioectomy.
  • Pathophysiology:
    – forces of atmospheric pressure and gravity overwhelm intracranial pressure causing herniation of brain
    – CSF hypovolemia and reduction of cerebral blood flow
    – Orthostatic positioning has been described to exacerbate the condition.
  • Symptoms
    – Non specific neurologic symptoms eg dizziness, memory loss, tinnitus
    – Psychiatric symptoms
    – Focal deficits, autonomic symptoms
  • Dx: CT scan is typical (prior craniectomy with mass effect)
  • Treatment: early cranioplasty results in normalization of the underlying pressure imbalance and recovery of neurologic function.


Flávio Ramalho Romero et al. Sinking skin flap syndrome with delayed dysautonomic syndrome—An atypical presentation. International Journal of Surgery Case Reports 4 (2013) 1007–1009


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