Stroke. 2010 Mar;41(3):560-2. doi: 10.1161/STROKEAHA.109.568543. Epub 2010 Jan 7.
"Sinking skin flap" (SSF) syndrome is a rare complication after large craniectomy that may progress to "paradoxical" herniation as a consequence of atmospheric pressure exceeding intracranial pressure. The prevalence and characteristics of SSF syndrome after hemicraniectomy for malignant infarction of the middle cerebral artery are not well known.
We analyzed a prospective cohort of 27 patients who underwent hemicraniectomy for malignant middle cerebral artery infarction. All had a clinical and brain imaging follow-up at 3 months and were followed until cranioplasty.
Three of 27 patients (11%) had, at 3 to 5 months posthemicraniectomy, SSF syndrome with severe orthostatic headache as the main symptom. In addition, 4 patients (15%) had radiological SSF syndrome but no clinical symptoms except partial seizures in one. Patients with SSF syndrome had a smaller surface of craniectomy (76.2 cm(2) versus 88.7 cm(2), P=0.05) and a tendency toward larger infarct volume, an older age, and a longer delay to cranioplasty than those without this syndrome.
SSF syndrome either clinically symptomatic or asymptomatic affects one fourth of patients 3 to 5 months after hemicraniectomy for malignant middle cerebral artery infarction. It should be diagnosed as early as possible to avoid progression to a paradoxical herniation.
“陷皮瓣（SSF）”综合征是一种罕见的大面积颅骨切除术后并发症，可能会由于大气压超过颅内压而进展为“矛盾性”疝。目前对于大脑中动脉恶性梗死患者行半脑切除术并发 SSF 综合征的发病率和特征还知之甚少。
我们分析了 27 例行半脑切除术治疗大脑中动脉恶性梗死的前瞻性队列患者。所有患者在术后 3 个月时进行临床和脑部影像学随访，并持续随访至颅骨修复术。
27 例患者中有 3 例（11%）在半脑切除术后 3 至 5 个月时出现 SSF 综合征，以严重直立性头痛为主要症状。此外，4 例（15%）有影像学 SSF 综合征，但除 1 例部分性癫痫发作外，无临床症状。与无 SSF 综合征的患者相比，有 SSF 综合征的患者颅骨切除术的面积较小（76.2cm² 比 88.7cm²，P=0.05），梗死体积较大，年龄较大，颅骨修复术的时间间隔也较长。
SSF 综合征无论是有症状还是无症状，都会在大脑中动脉恶性梗死患者行半脑切除术 3 至 5 个月后影响四分之一的患者。应尽早诊断以避免进展为矛盾性疝。
