ArticleNeurosurgical review2020
Sinking flap syndrome revisited: the who, when and why.
Article in Neurosurgical review, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.
- A comprehensive systematic review and meta-analysis study in comparing decompressive craniectomy versus craniotomy in patients with acute subdural hematoma.Neurosurgical review · 2024Pooled it
- Prevalence and clinical characterization of headache in patients with cranial bone defects: a single-center retrospective study.Acta neurologica Belgica · 2026Article
- Long-term outcomes following custom-made porous hydroxyapatite cranioplasty: a single-center experience of 234 consecutive cranioplasty procedures.Neurosurgical review · 2026Article
- Massive brain swelling after cranioplasty in the setting of severe sunken flap syndrome: illustrative case.Journal of neurosurgery. Case lessons · 2026Article
- The effectiveness of decompressive craniectomy size in traumatic brain injury; an international, observational, comparative effectiveness study.Brain & spine · 2026Article
- Cranioplasty as a therapeutic intervention for refractory postdecompressive craniectomy seizures in combat-traumatic brain injury: A report of two cases.Surgical neurology international · 2026Article
- Hemiplegia and sinking flap syndrome within 2 hours of decompressive craniectomy: A rare case following intraoperative cardiac arrest.Surgical neurology international · 2025Article
- Sunken flap following chest tube placement in the presence of ventriculopleural shunt: a case report.Journal of medical case reports · 2024Article
- Effectiveness of Additive Manufactured Titanium Implants in the Reconstruction of Large Cranial Defects: Case Series and Review of Literature.Journal of maxillofacial and oral surgery · 2024Article
- Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections.Clinical microbiology reviews · 2024Review
- Treatment of wound infections linked to neurosurgical implants.International wound journal · 2024Article
- New perspectives on assessment and understanding of the patient with cranial bone defect: a morphometric and cerebral radiodensity assessment.Frontiers in surgery · 2024Article
- Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography.Scientific reports · 2022Article
- Paradoxical herniation after decompressive craniectomy provoked by mannitol: A case report.World journal of clinical cases · 2022Article
- Environmental, Microbiological, and Immunological Features of Bacterial Biofilms Associated with Implanted Medical Devices.Clinical microbiology reviews · 2022Review
- Syndrome of the trephined: clinical spectrum, risk factors, and impact of cranioplasty on neurologic recovery in a prospective cohort.Neurosurgical review · 2022Article
- Clinical improvement after cranioplasty and its relation to body position and cerebral hemodynamics.Neurosurgical review · 2022Article
- Unusual presentation in syndrome of trephined - A unique case observation.Surgical neurology international · 2022Article
- Paradoxical Brain Herniation after Cranioplasty: Secondary Sunken Flap Syndrome.Journal of neurosciences in rural practice · 2022Article
- Cranioplasty: A Multidisciplinary Approach.Frontiers in surgery · 2022Review
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The sinking flap syndrome (SFS) is one of the complications of decompressive craniectomy (DC). Although frequently presenting with aspecific symptoms, that may be underestimated, it can lead to severe and progressive neurological deterioration and, if left untreated, even to death. We report our experience in a consecutive series of 43 patients diagnosed with SFS and propose a classification based on the possible etiopathogenetic mechanisms. In 10 years' time, 43 patients presenting with severely introflexed decompressive skin flaps plus radiological and clinical evidence of SFS were identified. We analysed potential factors involved in SFS development (demographics, time from decompression to deterioration, type, size and cause leading to DC, timing of cranioplasty, CSF dynamics disturbances, clinical presentation). Based on the collected data, we elaborated a classification system identifying 3 main SFS subtypes: (1) primary or atrophic, (2) secondary or hydrocephalic and (3) mixed. Very large DC, extensive brain damage, medial craniectomy border distance from the midline < 2 cm, re-surgery for craniectomy widening and CSF circulation derangements were found to be statistically associated with SFS. Cranioplasty led to permanent neurological improvement in 37 cases. In our series, SFS incidence was 16%, significantly larger than what is reported in the literature. Its management was more complex in patients affected by CSF circulation disturbances (especially when needing the removal of a contralateral infected cranioplasty or a resorbed bone flap). Although cranioplasty was always the winning solution, its appropriate timing was strategical and, if needed, we performed it even in an emergency, to ensure patient's improvement.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.