Asymmetric optic nerve sheath diameter as an outcome factor following cranioplasty in patients harboring the 'syndrome of the trephined'

作者：de Araujo Junior Antonio Santos^*; Arlant Pedro Alberto; Salvestrini Arnaldo Jr; Altieri Carlos Eduardo; Santos Jasper Guimaraes; Pinto Lauro Figueira; Fazzito Mirella Martins; Lee Hae Won; de Souza Godoy Luis Felipe

来源：Arquivos de Neuro-Psiquiatria, 2013, 71(12): 963-966.

DOI：10.1590/0004-282X20130176

• decompressive craniectomy
• syndrome of the trephined
• optic nerve

Decompressive craniectomy (DC) is gaining an increasing role in the neurosurgical treatment of intractable intracranial hypertension, but not without complications. A rare complication is the "syndrome of the trephined" (ST). It occurs when the forces of gravity overwhelm intracranial pressures, leading the brain to become sunken. Objective: To determine the usefulness of asymmetric optic nerve sheath diameter (ONSD) as an outcome factor after cranioplasty. Method: We followed-up 5 patients submitted to DC and diagnosed with ST. All were submitted to brain MRI to calculate the ONSD. Results: Only two patients presented an asymmetric ONSD, being ONSD larger at the site of craniectomy. Surprisingly these patients had a marked neurological improvement after cranioplasty. They became independent a week after and statistically earlier than others. Conclusion: It is presumed that the presence of an asymmetric ONSD in trephined patients is an independent factor of good outcome after cranioplasty.

• 出版日期2013-12