gms | German Medical Science

Objective: Decompressive craniectomies are often indicated for treating elevated intracranial pressure in neurosurgical patients. One of the complications of this procedure is the sinking flap syndrome (SFS), causing in some situations neurologic deterioration through a shift of brain structures. Etiology and pathogenesis are not well elucidated. Our objective was to determine the incidence of SFS in our patient collective and to identify risk factors.

Method: We retrospectively evaluated data of 48 patients who underwent lateral decompressive craniectomy from July 2008 till February 2011 in our department, who survived the acute disease and were subsequently treated by cranioplasty. Lesion type, side of pathology, age, sex, history of the patient including cardio vascular risk factors, National Institutes of Health-Score (NIH), Glasgow Coma Score (GSC), Glasgow Outcome Score (GOS), CT-scans and neurological symptoms were analyzed. Statistical significance was determined using the chi-square test.

Results: The most common indication for decompression was subdural hematoma followed by malignant infarction. Men were operated as twice as often as women. We found no difference between sides. Eight patient developed SFS (16%), three of them pronounced (6%). More patients with SFS had more frequent secondary neurologic deterioration in comparison to the other patients (p=0.01). Cranioplasty was performed earlier than in other cases (p=0.027). After cranioplsty, neurological condition improved in 7 cases. We couldn’t confirm any significant dependency between the main neurosurgical lesion type, different scores and other risk factors. Overall, we failed to find any significant improvement of GOS after cranioplasty after 3 months.

Conclusions: We failed to identify risk factors for sinking flap syndrome in patients who underwent craniectomy. The overall incidence of SFS in our cohort was 16%. Patient who developed SFS had significantly more secondary postoperative neurological deterioration; however cranioplasty appeared to improve neurological condition, warranting early bone flap replacement. However, cranioplasty didn’t improve overall outcome of patients after 3 months.