2073 Innovative Management of Sunken Flap Syndrome Post-Decompressive Craniectomy: A Case Report

INTRODUCTION: Sunken Flap Syndrome (SFS), also known as the syndrome of the trephined, presents a rare yet significant complication following decompressive craniectomy. Characterized by neurological deterioration attributed to alterations in cerebral hemodynamics and mechanics, SFS poses a complex challenge in post-surgical management. METHODS: We present an illustrative case of a 62-year-old male, unhelmeted bicyclist, who presented acutely after a bike versus pedestrian accident with acute subdural hematoma (SDH). RESULTS: Initial management involved a decompressive craniectomy and evacuation of the SDH. Postoperative course was complicated by SFS 21 days after surgery. He responded to postural measures, with improvement in Trendelenburg. Prosthetic cranioplasty was elected to be replaced early after 2 weeks. SFS resolved but the cranioplasty was complicated by wound dehiscence which necessitated removal of the prosthetic flap. The patient developed recurrent SFS that once again responded to postural measures. At this time, neck wrapping was attempted, which led to resolution of SFS. A trial with Q collar was made to mimic the effects of neck wrapping but failed to provide optimal venous pressure; thus, the neck wrap was applied again with resolution of SFS. CONCLUSIONS: We believe this case to be the first described case of SFS treated with neck wrapping. The use of neck wrapping provided a temporary yet effective solution for symptom management and patient mobilization, emphasizing the importance of individualized care approaches.