Arch Plast Surg.  2019 Jul;46(4):365-370. 10.5999/aps.2018.00360.

Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report

• Wang JS
• Ter Louw R
• DeFazio MV
• McGrail KM
• Evans KK

• KMID: 2459664
• DOI: http://doi.org/10.5999/aps.2018.00360

Abstract

The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed"”correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.

Keyword

Craniocerebral trauma; Neurologic manifestations; Reconstructive surgical procedures; Myocutaneous flap; Free tissue flaps

MeSH Terms

Cognition
Craniocerebral Trauma
Debridement
Follow-Up Studies
Free Tissue Flaps
Hemodynamics
Humans
Male
Metabolism
Middle Aged
Motor Skills
Myocutaneous Flap
Neurologic Manifestations
Postoperative Period
Reconstructive Surgical Procedures