TY - JOUR
T1 - Syndrome of the Trephined
T2 - A Systematic Review
AU - Ashayeri, Kimberly
AU - Jackson, Eric M.
AU - Huang, Judy
AU - Brem, Henry
AU - Gordon, Chad R.
N1 - Publisher Copyright:
Copyright © 2016 by the Congress of Neurological Surgeons.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - BACKGROUND: Syndrome of the trephined (SoT) is a rare, important complication of a craniectomy characterized by neurological dysfunction that improves with cranioplasty. Its varied symptoms include motor, cognitive, and language deficits. Its exact characterization appears suboptimal, with differing approaches of evaluation. Accordingly, this topic is in great need of further investigation. OBJECTIVE: To accurately describe SoT and explore methods of an objective diagnosis/evaluation. METHODS: Electronic searches of PubMed, MEDLINE, Web of Knowledge, and PsycINFO databases used the key words "syndrome of the trephined" and "sinking skin flap." Non-English-language and duplicate articles were eliminated. Title and abstract reviews were selected for relevance. Full-text reviews were selected for articles providing individual characteristics of SoT patients. RESULTS: This review identified that SoT most often occurs in male patients (60%) at 5.1 ± 10.8 months after craniectomy for neurotrauma (38%). The average reported craniectomy is 88.3 ± 34.4 cm 2 and usually exists with a "sunken skin flap" (93%). Symptoms most commonly include motor, cognitive, and language deficits (57%, 41%, 28%, respectively), with improvement after cranioplasty within 3.8 ± 3.9 days. Functional independence with activities of daily living is achieved by 54.9% of patients after 2.9 ± 3.4 months of rehabilitation. However, evaluation of SoT is inconsistent, with only 53% of reports documenting objective studies. DISCUSSION: SoT is a variable phenomenon associated with a prolonged time to cranioplasty. Due to current weaknesses in objectivity, we hypothesize that SoT is often underdiagnosed and recommend a multifaceted approach for consistent evaluation. CONCLUSION: SoT is a serious complication that lacks exact characterization and deserves future investigation. Improved understanding and recognition have important implications for early intervention and patient outcomes.
AB - BACKGROUND: Syndrome of the trephined (SoT) is a rare, important complication of a craniectomy characterized by neurological dysfunction that improves with cranioplasty. Its varied symptoms include motor, cognitive, and language deficits. Its exact characterization appears suboptimal, with differing approaches of evaluation. Accordingly, this topic is in great need of further investigation. OBJECTIVE: To accurately describe SoT and explore methods of an objective diagnosis/evaluation. METHODS: Electronic searches of PubMed, MEDLINE, Web of Knowledge, and PsycINFO databases used the key words "syndrome of the trephined" and "sinking skin flap." Non-English-language and duplicate articles were eliminated. Title and abstract reviews were selected for relevance. Full-text reviews were selected for articles providing individual characteristics of SoT patients. RESULTS: This review identified that SoT most often occurs in male patients (60%) at 5.1 ± 10.8 months after craniectomy for neurotrauma (38%). The average reported craniectomy is 88.3 ± 34.4 cm 2 and usually exists with a "sunken skin flap" (93%). Symptoms most commonly include motor, cognitive, and language deficits (57%, 41%, 28%, respectively), with improvement after cranioplasty within 3.8 ± 3.9 days. Functional independence with activities of daily living is achieved by 54.9% of patients after 2.9 ± 3.4 months of rehabilitation. However, evaluation of SoT is inconsistent, with only 53% of reports documenting objective studies. DISCUSSION: SoT is a variable phenomenon associated with a prolonged time to cranioplasty. Due to current weaknesses in objectivity, we hypothesize that SoT is often underdiagnosed and recommend a multifaceted approach for consistent evaluation. CONCLUSION: SoT is a serious complication that lacks exact characterization and deserves future investigation. Improved understanding and recognition have important implications for early intervention and patient outcomes.
KW - Craniofacial reconstruction
KW - Cranioplasty
KW - Decompressive craniectomy
KW - Neurosurgery
KW - Rehabilitation
KW - Syndrome of the trephined
KW - Systematic review
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U2 - 10.1227/NEU.0000000000001366
DO - 10.1227/NEU.0000000000001366
M3 - Article
C2 - 27489166
AN - SCOPUS:84980340019
SN - 0148-396X
VL - 79
SP - 525
EP - 533
JO - Neurosurgery
JF - Neurosurgery
IS - 4
ER -