Korean J Neurotrauma.  2012 Oct;8(2):149-152. 10.13004/kjnt.2012.8.2.149.

Sinking Skin Flap Syndrome after Craniectomy in a Patient Who Previously Underwent Ventriculoperitoneal Shunt

• Kim SY
• Lee CH
• Park IS
• Hwang SH
• Han JW

• KMID: 1427730
• DOI: http://doi.org/10.13004/kjnt.2012.8.2.149

Abstract

Sinking skin flap syndrome, resulting from decompressive craniectomy, is defined as a series of neurologic symptoms with skin depression at the site of cranial defect. A 61-year-old male was hospitalized with high fever and operative site swelling. He underwent decompressive craniectomy on his left side for treatment for acute subdural hematoma and traumatic intracerebral hematoma 5 years ago. Four months later, a ventriculoperitoneal shunt was performed for treatment for hydrocephalus and cranioplasty was also performed. We suspected infection at the previous operative site and proceeded with craniectomy and epidural abscess removal. Following the procedure, the depression of the sinking flap became significant, and he has suffered from right hemiparesis. We performed a shunt catheter tie at the level of the right clavicle under local anesthesia, and the patient recovered his health to his baseline. We present a patient who was successfully managed with a tie of the shunt catheter for sinking skin flap syndrome.

Keyword

Decompressive craniectomy; Sinking skin flap syndrome; Ventriculoperitoneal shunt

MeSH Terms

Anesthesia, Local
Catheters
Clavicle
Decompressive Craniectomy
Depression
Epidural Abscess
Fever
Hematoma
Hematoma, Subdural, Acute
Humans
Hydrocephalus
Male
Neurologic Manifestations
Paresis
Skin
Ventriculoperitoneal Shunt

Figure

• 

  FIGURE 1. Brain computed tomography (CT) showed acute subdural hematoma and traumatic intracerebral hematoma on the left frontotemporal region with significant mass effect and midline shift to the right at 5 years ago (A) and brain CT after ventriculoperitoneal shunt via right Kocher's point and cranioplasty were performed (B).

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  FIGURE 2. Brain computed tomography after 5 years. It revealed a low density around the left frontotemporal bone and soft tissue swelling.

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  FIGURE 3. Brain computed tomography after bone flap removal. It revealed marked concavity of the brain at the defect site of the craniectomy associated with severe midline shift to the right.

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  FIGURE 4. Follow up computed tomography scan shows restoration of the midline shift without significant complication compared to the previous image.

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