Bateman Emma A, VanderEnde Jordan, Sequeira Keith, MacKenzie Heather M
Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Parkwood Institute, St Joseph's Health Care London, London, ON, Canada.
NeuroRehabilitation. 2021;49(4):663-672. doi: 10.3233/NRE-210160.
Hemicraniectomy to manage raised intracranial pressure following traumatic brain injury (TBI) has improved survival but may increase the incidence of Sinking Skin Flap Syndrome (SSFS). SSFS is a clinical syndrome in which patients with craniectomy develop objective neurologic abnormalities due to the pressure of the atmosphere on the unprotected brain, often presenting with postural headaches and neurologic deficits that localize to the craniectomy site. Previously thought to be a rare complication of craniectomy after TBI, evidence suggests SSFS is under-recognized.
To describe the clinical and radiographic features leading to diagnosis and the impact of temporizing and definitive management of SSFS on outcomes in inpatients with moderate/severe TBI.
Two patients' symptoms, qualitative behaviour observation, physical and cognitive outcome measures, and neuroimaging pre- and post-temporizing measures and cranioplasty are presented.
Both patients demonstrated partial improvements with temporizing measures and substantial improvements in functional, cognitive, physical, and rehabilitation outcomes from the cranioplasty and resolution of SSFS.
Rehabilitation care providers are critical to the timely diagnosis and management of SSFS, including the use of temporizing measures and advocacy for definitive treatment with cranioplasty. These cases highlight the diverse clinical presentations and importance of SSFS diagnosis to improve patient outcomes.
外伤性脑损伤（TBI）后采用去骨瓣减压术治疗颅内压升高可提高生存率，但可能会增加下沉皮瓣综合征（SSFS）的发生率。SSFS是一种临床综合征，接受颅骨切除术的患者由于大气对未受保护的大脑施加压力而出现客观的神经功能异常，常表现为体位性头痛和局限于颅骨切除部位的神经功能缺损。以前认为这是TBI后颅骨切除术的一种罕见并发症，但有证据表明SSFS未得到充分认识。
描述导致诊断的临床和影像学特征，以及SSFS的临时和确定性治疗对中重度TBI住院患者预后的影响。
介绍了两名患者的症状、定性行为观察、身体和认知结局指标，以及临时治疗前后的神经影像学检查和颅骨修补术情况。
两名患者在采取临时措施后均有部分改善，颅骨修补术和SSFS的缓解使功能、认知、身体和康复结局有了显著改善。
康复护理人员对于SSFS的及时诊断和治疗至关重要，包括采用临时措施以及倡导进行颅骨修补术的确定性治疗。这些病例突出了SSFS多样的临床表现以及诊断对于改善患者预后的重要性。
