Document Detail


Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction.
MedLine Citation:
PMID:  20056926     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: "Sinking skin flap" (SSF) syndrome is a rare complication after large craniectomy that may progress to "paradoxical" herniation as a consequence of atmospheric pressure exceeding intracranial pressure. The prevalence and characteristics of SSF syndrome after hemicraniectomy for malignant infarction of the middle cerebral artery are not well known. METHODS: We analyzed a prospective cohort of 27 patients who underwent hemicraniectomy for malignant middle cerebral artery infarction. All had a clinical and brain imaging follow-up at 3 months and were followed until cranioplasty. RESULTS: Three of 27 patients (11%) had, at 3 to 5 months posthemicraniectomy, SSF syndrome with severe orthostatic headache as the main symptom. In addition, 4 patients (15%) had radiological SSF syndrome but no clinical symptoms except partial seizures in one. Patients with SSF syndrome had a smaller surface of craniectomy (76.2 cm(2) versus 88.7 cm(2), P=0.05) and a tendency toward larger infarct volume, an older age, and a longer delay to cranioplasty than those without this syndrome. CONCLUSIONS: SSF syndrome either clinically symptomatic or asymptomatic affects one fourth of patients 3 to 5 months after hemicraniectomy for malignant middle cerebral artery infarction. It should be diagnosed as early as possible to avoid progression to a paradoxical herniation.
Authors:
Mariana Sarov; Jean-Pierre Guichard; Salvatore Chibarro; Emilie Guettard; Ophelia Godin; Alain Yelnik; Bernard George; Marie-Germaine Bousser; Katayoun Vahedi;
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Publication Detail:
Type:  Comparative Study; Letter; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-01-07
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  41     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-23     Completed Date:  2010-04-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  560-2     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebral Infarction / pathology,  surgery*
Cohort Studies
Decompressive Craniectomy / adverse effects*
Female
Follow-Up Studies
Hernia
Humans
Male
Middle Aged
Postoperative Complications / diagnosis*,  etiology
Prospective Studies
Surgical Flaps / adverse effects*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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