Cranioplasty For Treatment of Syndrome of The Trephined: Case Report And Literature Review
Pedro Nogarotto Cembraneli, Julia Brasileiro de Faria Cavalcante, Italo Nogarotto Cembraneli, Renata Brasileiro de Faria Cavalcante, José Edison da Silva Cavalcante, Leonardo Taveira Lopes, Alessandro Fonseca Cardoso, Chrystiano Fonseca Cardoso
Syndrome of the Trephined (ST) is a neurological complication observed after decompressive
craniectomies, characterized by progressive neurological deterioration linked to the removal of a
significant portion of the skull. ST commonly occurs in patients with severe traumatic brain injury, stroke,
or other conditions causing intracranial hypertension. While rare, its clinical relevance is significant
due to the impact on patient recovery. The syndrome's incidence varies depending on the clinical context,
with risk factors including hemorrhagic injuries and brain displacement. In Brazil, its prevalence is
underreported, partly due to the lack of large studies, though the incidence has risen with the increasing
use of decompressive craniectomies in cases of severe intracranial hypertension. We present a case of a
69-year-old male patient with ST after a decompressive craniectomy for acute subdural hematoma and
cerebral edema following trauma. Cranioplasty was performed to address the bone defect, and postsurgical recovery showed significant motor improvement, although swallowing difficulties persisted.
The primary therapeutic approach for ST is cranioplasty, with early intervention shown to improve
neurological outcomes. Early cranioplasty, performed within 30 days of decompressive craniectomy,
leads to a recovery rate of up to 75%. This case highlights the importance of timely surgical intervention
and the need for further studies on ST, particularly focusing on its epidemiology and pathophysiology
in Brazil.
