Section of Plastic and Reconstructive Surgery, Department of Surgery, Spectrum Health Michigan State University College of Human Medicine.
Plastic Surgery Associates, Grand Rapids, MI.
J Craniofac Surg. 2020 Oct;31(7):e705-e707. 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.
去骨瓣减压术是一种越来越多地用于缓解对药物治疗有抗性的颅内高压的干预措施。尽管有治疗益处，但一旦固定容积的颅盖保持减压，就可能会出现许多短期和长期并发症。作者报告了一例在反复行去骨瓣减压和颅骨成形术的患者中出现复发性环锯术后综合征的病例。
一名 70 岁男性，有吸烟和慢性阻塞性肺疾病史，因平地跌倒导致额顶骨硬膜下血肿伴中线移位而行开颅术和血肿清除术。术后 3 个月，患者发生开颅骨瓣感染，需要行去骨瓣减压术而无需颅骨成形术。去骨瓣减压术后 6 周，患者出现右侧感觉运动功能障碍和找词困难。感染得到控制后进行了异体颅骨成形术，6 周后颅骨成形术后神经系统症状得到缓解。由于反复发生颅骨成形术感染，进行了多次异体颅骨成形术，每次去骨瓣减压后均可靠地再现神经系统症状，并在每次颅骨成形术后得到缓解。最终使用新的异体植入物结合背阔肌皮瓣成功完成了最终的颅骨成形术，随后神经系统功能恢复。
去骨瓣减压术是一种救命的手术，但会带来许多短期和长期的并发症，包括环锯术后综合征。据我们所知，我们的病例是第一个报告显示复发性环锯术后综合征作为去骨瓣减压术并发症的病例，该综合征可靠地通过恢复颅盖得到缓解。
