Outcome of Early Cranioplasty in Trephine Syndrome or Paradoxical Brain Herniation: A Case Report and Literature Review

Sinking skin flap syndrome (SSFS) is a rare complication observed in patients after craniectomy. The intracranial pressure is decreased after craniectomy, resulting in some conditions. These include mental change, focal deficits, headache, seizures, and dysautonomia. Cranioplasty is the most commonly used treatment method for SSFS. Here, the case of a patient is presented with symptoms, including sudden loss of consciousness, aphasia, and right-side weakness. A computed tomography (CT) scan revealed hemorrhagic conversion of parietotemporal infarct with midline shift. A decompressive craniectomy was performed, and the patient developed SSFS later. Subsequently, the patient underwent cranioplasty and showed improvements in neurological deficits. SSFS is rare; only a few cases have been reported in the literature.