Recurrent Syndrome of the Trephined in the Setting of Multiple Craniectomy and Cranioplasty

• Published in: The Journal of craniofacial surgery Vol. 31; no. 7; pp. e705 - e707
• Main Authors: Kaura, Arminder S., Fahrenkopf, Matthew P., Kelpin, John P., Krebiehl, Johanna R.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-10-2020
• Subjects: Aged; Dentistry; Humans; Male; Postoperative Complications; Reconstructive Surgical Procedures; Skull - diagnostic imaging; Skull - surgery; Surgical Flaps - surgery; Treatment Outcome
• ISSN: 1049-2275; 1536-3732
• DOI: 10.1097/SCS.0000000000006625

Decompressive craniectomy is an increasingly implemented intervention for relief of intracranial hypertension refractory to medical therapy. Despite its therapeutic benefit, a myriad of short and long-term complications may arise when the once fixed-volume cranial vault remains decompressed. The authors present a case of recurrent Syndrome of the Trephined in a patient undergoing repeated craniectomy and cranioplasty.A 70-year old male with history significant for smoking and chronic obstructive pulmonary disease presented with frontoparietal subdural hematoma with midline shift following a ground level fall necessitating craniotomy and hematoma evacuation. Three months postoperatively, the patient developed an infection of his craniotomy bone flap necessitating craniectomy without cranioplasty. Six weeks post-craniectomy the patient began demonstrating right sided sensorimotor deficits with word finding difficulties. Alloplastic cranioplasty was performed following resolution of infection, with resolution of neurologic symptoms 6 weeks post cranioplasty. Due to recurrent cranioplasty infections, multiple alloplastic cranioplasties were performed, each with reliable re-demonstration of neurologic symptoms with craniectomy, and subsequent resolution following each cranioplasty. Final cranioplasty was successfully performed using a new alloplastic implant in combination with latissimus muscle flap, with subsequent return of neurologic function.Decompressive craniectomy is a life-saving procedure, but carries many short- and long-term complications, including the Syndrome of the Trephined. Our case is the first published report, to our knowledge, to demonstrate recurrent Syndrome of the Trephined as a complication of craniectomy, with reliable resolution of the syndrome with restoration of the cranial vault.