Cranioplasty For Treatment of Syndrome of The Trephined: Case Report And Literature Review

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.