Anei Ryogo, Uemori Genki, Orimoto Ryosuke, Saito Masato, Hirosima Satosi, Mitsui Nobuyuki, Hayasi Yosimitu, Sato Masao, Hododuka Akira, Kamada Kyousuke
Department of Neurosurgery, Asahikawa Medical College, Hokkaido, Japan.
No Shinkei Geka. 2010 Oct;38(10):923-6.
Marked depression of the skin flap after external decompressive craniotomy, affecting the brain function, is known as sinking flap syndrome. However, to our knowledge, there have been no reports of delayed sinking of the entire bone flap after the procedure, inducing neurological symptoms. We encountered a patient with neurological symptoms due to sinking of the entire bone flap 15 years after the first operation. A 59-year-old male underwent clipping by craniotomy due to subarachnoid hemorrhage resulting from the rupture of a left internal carotid aneurysm 15 years earlier. He was discharged, but developed paresis in the right upper and lower limbs 6 months before symptom onset. CT showed sinking of the free bone flap, while MRI revealed left uncal herniation. After uncal resection and free flap fixation, the symptoms improved. This case confirmed the necessity of firm bone flap fixation at the time of cranial closure.
外减压开颅术后皮瓣明显凹陷，影响脑功能，称为皮瓣下陷综合征。然而，据我们所知，术后整块骨瓣延迟下陷并诱发神经症状尚无报道。我们遇到一名患者，在首次手术后15年因整块骨瓣下陷出现神经症状。一名59岁男性15年前因左侧颈内动脉瘤破裂导致蛛网膜下腔出血接受开颅夹闭术。他出院后，但在症状出现前6个月出现右上肢和下肢轻瘫。CT显示游离骨瓣下陷，而MRI显示左侧钩回疝。在进行钩回切除和游离骨瓣固定后，症状改善。该病例证实了颅骨闭合时牢固固定骨瓣的必要性。
