From the Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine at Temple University; the Division of Plastic and Reconstructive Surgery, Northwell Health Hofstra School of Medicine; the Division of Plastic and Reconstructive Surgery, University of Kansas; and the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles David Geffen School of Medicine.
Plast Reconstr Surg. 2020 Jun;145(6):1486-1494. doi: 10.1097/PRS.0000000000006836.
Large decompressive craniectomies may be life-saving; however, they may also result in syndrome of the trephined. This postrecovery sequela is characterized by dizziness, fatigue, depression, weakness, speech slowing, gait disturbance, and impaired mentation. Because this entity is poorly understood, the authors attempted to quantify the functional improvement in patients with syndrome of the trephined after cranial vault reconstruction.
Patients with cranial vault defects (>50 cm) from trauma, meningioma, and hemorrhage were studied preoperatively and postoperatively (6 months) after cranial vault reconstruction using (1) the Cognistat Active Form and (2) the Functional Independence Measure instrument (n = 40). Cranial vault reconstructive techniques varied from split cranial bone to alloplastic implants (polyetheretherketone or titanium mesh).
Of the 143 patients treated with decompressive craniectomies, 28 percent (n = 40) developed symptoms of syndrome of the trephined. A larger craniectomy defect size correlated with development of syndrome of the trephined. Time from craniectomy to presentation of symptoms was 4.5 months. Time from craniectomy to cranial vault reconstruction was 6.1 months. Time from cranial vault reconstruction to symptom improvement was 4.3 days. Complete functional recovery of syndrome of the trephined was seen in 70 percent. Type of cranial vault reconstruction included polyetheretherketone implant (57.5 percent), split calvarial graft (22.5 percent), and titanium mesh (20 percent), and was not a determinant of functional improvement. Cognistat assessment score noted improvement (from 38 to 69); likewise, the Functional Independence Measure measurement tool showed improvement (from 38 to 98).
Syndrome of the trephined occurs more frequently than previously described in posttraumatic patients with large cranial vault defects. Cranial vault reconstruction leads to significant, quantifiable functional improvement in a large number of patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
大骨瓣减压术可能是救命的；然而，它们也可能导致环锯术后综合征。这种康复后的后遗症的特征是头晕、疲劳、抑郁、虚弱、言语迟缓、步态障碍和认知障碍。由于这种疾病了解甚少，作者试图量化颅骨重建后环锯术后综合征患者的功能改善情况。
研究对象为因创伤、脑膜瘤和出血而导致颅骨穹窿缺损（>50cm）的患者，在颅骨重建术前和术后（6 个月）使用（1）Cognistat 主动式量表和（2）功能独立性量表进行评估（n=40）。颅骨重建技术从颅骨劈裂到各种植入物（聚醚醚酮或钛网）。
在接受减压性颅骨切除术的 143 例患者中，28%（n=40）出现了环锯术后综合征的症状。较大的颅骨切除术缺损与环锯术后综合征的发生相关。从颅骨切除术到出现症状的时间为 4.5 个月。从颅骨切除术到颅骨重建的时间为 6.1 个月。从颅骨重建到症状改善的时间为 4.3 天。70%的环锯术后综合征患者完全康复。颅骨重建的类型包括聚醚醚酮植入物（57.5%）、颅骨劈开移植（22.5%）和钛网（20%），但不是功能改善的决定因素。Cognistat 评估量表评分有所提高（从 38 提高到 69）；同样，功能独立性测量工具也显示出改善（从 38 提高到 98）。
与先前报道的创伤后大颅骨缺损患者相比，环锯术后综合征的发生率更高。颅骨重建可显著改善大量患者的功能。
临床问题/证据水平：治疗性，IV。
