An Extreme Case of the Syndrome of the Trephined Requiring the Use of a Novel Titanium Plate

作者：Chalouhi Nohra; Teufack Sonia; Gonzalez L Fernando; Rosenwasser Robert H; Jabbour Pascal M^*

来源：Neurologist, 2012, 18(6): 423-425.

DOI：10.1097/NRL.0b013e318272f7be

• hemicraniectomy
• syndrome of the trephined
• cranioplasty

Introduction: Patients with large cranial defects can manifest a secondary neurological deterioration known as the %26quot;syndrome of the trephined.%26quot; %26lt;br%26gt;Case Report: This is the case of a 66-year-old female with a left-sided acute subdural hematoma, treated with decompressive craniectomy. Six months later, a cranioplasty was performed. However, it was complicated by an infection requiring removal of the bone plate. A week later, the patient became comatose; her craniectomy flap was sunken. After ruling out all other possible disorders, we suspected an extreme syndrome of the trephined. The patient%26apos;s neurological status drastically improved after she was placed on a Trendelenburg position regiment. A second cranioplasty was performed only 3 months after the infection using a novel custom designed titanium mesh, the least porous material used in synthetic bone flaps, to decrease the risk of infection. The patient had an excellent recovery; at her 6-month follow-up she was neurologically intact, cosmetically satisfied, and free of infection. %26lt;br%26gt;Conclusions: The treatment of extreme cases of syndrome of the trephined in the setting of a recent infection can be challenging; successful treatment can be achieved by using a custom titanium plate.

• 出版日期2012-11