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Sinking skin flap syndrome visualized by upright computed tomography

  • Case Report - Neurosurgery general
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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.

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Abbreviations

CSF:

Cerebrospinal fluid

CT:

Computed tomography

ICP:

Intracranial pressure

SSFS:

Sinking skin flap syndrome

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Acknowledgments

The authors would like to thank Enago (www.enago.jp) for the English language review.

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Authors and Affiliations

  1. Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Keisuke Yoshida, Masahiro Toda, Kenzo Kosugi, Mariko Fukumura, Kazunari Koike, Satoshi Takahashi & Kazunari Yoshida

  2. Department of Radiology, Keio University School of Medicine, Tokyo, Japan

    Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Hirokazu Fujiwara & Masahiro Jinzaki

Authors
  1. Keisuke Yoshida
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  2. Masahiro Toda
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  3. Yoshitake Yamada
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  4. Minoru Yamada
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  5. Yoichi Yokoyama
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  6. Hirokazu Fujiwara
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  7. Kenzo Kosugi
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  8. Mariko Fukumura
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  9. Kazunari Koike
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  10. Satoshi Takahashi
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  11. Kazunari Yoshida
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  12. Masahiro Jinzaki
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. The first draft of the manuscript was written by Keisuke Yoshida, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Masahiro Toda.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Approval was obtained from the ethics committee of Keio University School of Medicine. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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The patient consented to the submission of the case report to the journal.

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Yoshida, K., Toda, M., Yamada, Y. et al. Sinking skin flap syndrome visualized by upright computed tomography. Acta Neurochir 162, 1825–1828 (2020). https://doi.org/10.1007/s00701-020-04459-7

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  • DOI: https://doi.org/10.1007/s00701-020-04459-7

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