Sinking flap syndrome revisited: the who, when and why

Neurosurgical Review
Alessandro Di RienzoMaurizio Iacoangeli

Abstract

The sinking flap syndrome (SFS) is one of the complications of decompressive craniectomy (DC). Although frequently presenting with aspecific symptoms, that may be underestimated, it can lead to severe and progressive neurological deterioration and, if left untreated, even to death. We report our experience in a consecutive series of 43 patients diagnosed with SFS and propose a classification based on the possible etiopathogenetic mechanisms. In 10 years' time, 43 patients presenting with severely introflexed decompressive skin flaps plus radiological and clinical evidence of SFS were identified. We analysed potential factors involved in SFS development (demographics, time from decompression to deterioration, type, size and cause leading to DC, timing of cranioplasty, CSF dynamics disturbances, clinical presentation). Based on the collected data, we elaborated a classification system identifying 3 main SFS subtypes: (1) primary or atrophic, (2) secondary or hydrocephalic and (3) mixed. Very large DC, extensive brain damage, medial craniectomy border distance from the midline < 2 cm, re-surgery for craniectomy widening and CSF circulation derangements were found to be statistically associated with SFS. Cranioplasty led to permane...Continue Reading

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Citations

Jun 24, 2020·Acta neurochirurgica·Keisuke YoshidaMasahiro Jinzaki
Jan 19, 2020·Journal of Neurology·Taco GoedemansPepijn van den Munckhof
Jan 13, 2021·Scientific Reports·Yoichi YokoyamaMasahiro Jinzaki
Feb 26, 2021·Case Reports in Neurological Medicine·Ashish ChughSarang Gotecha
Sep 29, 2021·British Journal of Neurosurgery·Airi KugisakiShunsuke Ichi

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