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Sinking Skin Flap Syndrome After Decompressive Craniectomy

A Case Report

Fawley, Nicholas, DO; Udeh, Chiedozie, MBBS, FCCP

doi: 10.1213/XAA.0000000000000795
Case Reports

Sinking skin flap syndrome is a rare complication of decompressive craniectomy characterized by a sunken skin flap, neurological deterioration, and paradoxical herniation of the brain. An absent cranium allows for external compression via atmospheric pressure, causing alterations in cerebral blood flow, cerebral spinal fluid flow, and glucose metabolism, which ultimately leads to cortical dysfunction. This case report describes a patient with relatively early onset of variable neurological symptoms and imaging correlation, leading to a diagnosis and definitive therapeutic intervention with cranioplasty. Prompt recognition is critical to avoid potentially devastating neurological outcomes in this rare, but underreported condition.

From the Center for Critical Care, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

Accepted for publication April 4, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Chiedozie Udeh, MBBS, FCCP, Center for Critical Care, Anesthesiology Institute, 9500 Euclid Ave (J4-331), Cleveland, OH 44195. Address e-mail to

© 2018 International Anesthesia Research Society
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