Sinking Skin Flap Syndrome after Craniectomy in a Patient Who Previously Underwent Ventriculoperitoneal Shunt

Abstract

Sinking skin flap syndrome, resulting from decompressive craniectomy, is defined as a series of neurologic symptoms with skin depression at the site of cranial defect. A 61-year-old male was hospitalized with high fever and operative site swelling. He underwent decompressive craniectomy on his left side for treatment for acute subdural hematoma and traumatic intrace- rebral hematoma 5 years ago. Four months later, a ventriculoperitoneal shunt was performed for treatment for hydrocepha- lus and cranioplasty was also performed. We suspected infection at the previous operative site and proceeded with craniec- tomy and epidural abscess removal. Following the procedure, the depression of the sinking flap became significant, and he has suffered from right hemiparesis. We performed a shunt catheter tie at the level of the right clavicle under local anesthesia, and the patient recovered his health to his baseline. We present a patient who was successfully managed with a tie of the shunt cath- eter for sinking skin flap syndrome. (Korean J Neurotrauma 2012;8:149-152)