Rapid development and resolution of sinking skin flap syndrome in a patient following decompressive craniectomy
Sinking skin flap syndrome (SSS) is a serious complication following decompressive craniectomy (DC).
Although CSF hypovolemia and exposure to atmospheric pressure have been attributed as causative factors,
the definite etiologies remain elusive. We present a case where a patient had a rapid deterioration without
any warning sign following a diagnostic and therapeutic lumbar puncture after DC. The patient had rapid
fluctuation of symptoms with change of position. She was managed conservatively and finally achieved
a full neurologic recovery without cranioplasty. This case report shows the heterogeneity of SSS and that
cranioplasty may not be required in acute cases.
Keywords: CSF diversion, Cerebral herniation, Hemicraniectomy
Although CSF hypovolemia and exposure to atmospheric pressure have been attributed as causative factors,
the definite etiologies remain elusive. We present a case where a patient had a rapid deterioration without
any warning sign following a diagnostic and therapeutic lumbar puncture after DC. The patient had rapid
fluctuation of symptoms with change of position. She was managed conservatively and finally achieved
a full neurologic recovery without cranioplasty. This case report shows the heterogeneity of SSS and that
cranioplasty may not be required in acute cases.
Keywords: CSF diversion, Cerebral herniation, Hemicraniectomy