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<p>One of the possible, though rare, complications of surgical decompressive craniectomy is the sinking skin flap (SSF) syndrome. This occurs in a wide variety of neurovascular, neurosurgical or neuro-traumatic conditions. Though symptoms are non-specific, this condition could be potentially fatal if not promptly identified and managed. We report a case of a 59-year-old Caucasian man admitted with a malignant middle cerebral artery (MCA) infarct who subsequently had decompressive hemicraniectomy. Following worsening consciousness and neurologic deficit associated&#xa0;with sunken skin 3&#xa0;weeks after decompressive hemicraniectomy, an urgent repeat CT imaging revealed an SSF syndrome. A protective 3-dimensional-printed helmet, elevated bed at about 30° and an elective autologous cranioplasty improved his outcome. This is a rare case of further neurologic complication in a patient with malignant MCA infarct with decompressive hemicraniectomy. This case highlights the high suspicion index of this non-specific, potentially life-threatening condition in a patient with large territory stroke treated by hemicraniectomy.</p>

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Sinking Skin Flap Syndrome as a Post-craniectomy Complication after Malignant Middle Cerebral Artery Infarct: a Case Report

  • 期刊论文

  • 发表日期：

    2025年2月11日

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  • Michel K. Mengnjo,
  • Nnamdi Morah,
  • Chrisostomos Muwonge,
  • Xavier Leonard,
  • Arran Willott,
  • Babu Pusuluri,
  • Robert Whiting,
  • Miriam Harvey,
  • Malik Hussain,
  • Dumin Karunatilake

摘要

One of the possible, though rare, complications of surgical decompressive craniectomy is the sinking skin flap (SSF) syndrome. This occurs in a wide variety of neurovascular, neurosurgical or neuro-traumatic conditions. Though symptoms are non-specific, this condition could be potentially fatal if not promptly identified and managed. We report a case of a 59-year-old Caucasian man admitted with a malignant middle cerebral artery (MCA) infarct who subsequently had decompressive hemicraniectomy. Following worsening consciousness and neurologic deficit associated with sunken skin 3 weeks after decompressive hemicraniectomy, an urgent repeat CT imaging revealed an SSF syndrome. A protective 3-dimensional-printed helmet, elevated bed at about 30° and an elective autologous cranioplasty improved his outcome. This is a rare case of further neurologic complication in a patient with malignant MCA infarct with decompressive hemicraniectomy. This case highlights the high suspicion index of this non-specific, potentially life-threatening condition in a patient with large territory stroke treated by hemicraniectomy.