| Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction. | |
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MedLine Citation:
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PMID: 20056926 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Letter; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2010-01-07 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 41 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-02-23 Completed Date: 2010-04-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 560-2 Citation Subset: IM |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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 |
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