Sinking skin flap syndrome visualized by upright computed tomography

Keisuke Yoshida; Masahiro Toda; Yoshitake Yamada; Minoru Yamada; Yoichi Yokoyama; Hirokazu Fujiwara; Kenzo Kosugi; Mariko Fukumura; Kazunari Koike; Satoshi Takahashi; Kazunari Yoshida; Masahiro Jinzaki

doi:10.1007/s00701-020-04459-7

Sinking skin flap syndrome visualized by upright computed tomography

Keisuke Yoshida, Masahiro Toda, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Hirokazu Fujiwara, Kenzo Kosugi, Mariko Fukumura, Kazunari Koike, Satoshi Takahashi, Kazunari Yoshida, Masahiro Jinzaki

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. Upright computed tomography (CT) before cranioplasty showed a remarkable shift of the brain compared to supine CT. After cranioplasty, both symptoms and brain shift on CT resolved. Upright CT enables detection and objective evaluation of paradoxical herniation and midline shift that is not obvious on supine imaging modalities. Clinicians need to be aware of positional brain shift in postcraniectomy patients.

Original language	English
Pages (from-to)	1825-1828
Number of pages	4
Journal	Acta Neurochirurgica
Volume	162
Issue number	8
DOIs	https://doi.org/10.1007/s00701-020-04459-7
Publication status	Published - 2020 Aug 1

Keywords

Craniectomy
Cranioplasty
Sinking skin flap syndrome
Syndrome of the trephined
Upright CT

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1007/s00701-020-04459-7

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title = "Sinking skin flap syndrome visualized by upright computed tomography",

abstract = "Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. Upright computed tomography (CT) before cranioplasty showed a remarkable shift of the brain compared to supine CT. After cranioplasty, both symptoms and brain shift on CT resolved. Upright CT enables detection and objective evaluation of paradoxical herniation and midline shift that is not obvious on supine imaging modalities. Clinicians need to be aware of positional brain shift in postcraniectomy patients.",

keywords = "Craniectomy, Cranioplasty, Sinking skin flap syndrome, Syndrome of the trephined, Upright CT",

author = "Keisuke Yoshida and Masahiro Toda and Yoshitake Yamada and Minoru Yamada and Yoichi Yokoyama and Hirokazu Fujiwara and Kenzo Kosugi and Mariko Fukumura and Kazunari Koike and Satoshi Takahashi and Kazunari Yoshida and Masahiro Jinzaki",

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doi = "10.1007/s00701-020-04459-7",

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T1 - Sinking skin flap syndrome visualized by upright computed tomography

AU - Yoshida, Keisuke

AU - Toda, Masahiro

AU - Yamada, Yoshitake

AU - Yamada, Minoru

AU - Yokoyama, Yoichi

AU - Fujiwara, Hirokazu

AU - Kosugi, Kenzo

AU - Fukumura, Mariko

AU - Koike, Kazunari

AU - Takahashi, Satoshi

AU - Yoshida, Kazunari

AU - Jinzaki, Masahiro

PY - 2020/8/1

Y1 - 2020/8/1

N2 - Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. Upright computed tomography (CT) before cranioplasty showed a remarkable shift of the brain compared to supine CT. After cranioplasty, both symptoms and brain shift on CT resolved. Upright CT enables detection and objective evaluation of paradoxical herniation and midline shift that is not obvious on supine imaging modalities. Clinicians need to be aware of positional brain shift in postcraniectomy patients.

AB - Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. Upright computed tomography (CT) before cranioplasty showed a remarkable shift of the brain compared to supine CT. After cranioplasty, both symptoms and brain shift on CT resolved. Upright CT enables detection and objective evaluation of paradoxical herniation and midline shift that is not obvious on supine imaging modalities. Clinicians need to be aware of positional brain shift in postcraniectomy patients.

KW - Craniectomy

KW - Cranioplasty

KW - Sinking skin flap syndrome

KW - Syndrome of the trephined

KW - Upright CT

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JO - Acta Neurochirurgica

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IS - 8

ER -

Sinking skin flap syndrome visualized by upright computed tomography

Abstract

Keywords

ASJC Scopus subject areas

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