Cranioplasty with a 3D-printed titanium implant for post-decompressive craniectomy syndrome: A case report

Background: Decompressive craniectomy (DC) is a life-saving intervention for severe traumatic brain injury (TBI), but often results in large cranial defects leading to syndrome of the trephined (ST)- a neurological condition characterized by headaches, cognitive decline, and motor deficits caused by atmospheric pressure acting on the unshielded brain. Case Description: This report describes a 45-year-old male who developed debilitating post-craniectomy headaches and cognitive deficits. While preoperative imaging suggested cerebral atrophy, the diagnosis of ST was confirmed by distinguishing reversible parenchymal compression from permanent atrophy, paradoxical herniation, and hydrocephalus. A custom 3D-printed titanium implant featuring a novel in situ -generated selenium nanoparticle (SeNP) surface was used to repair the defect. Following the procedure, the patient experienced a complete resolution of his headaches (Visual Analog Scale score 8/10 to 0/10) and a significant functional recovery. Conclusion: Postoperative imaging demonstrated rapid cerebral re-expansion and normalization of ventricular caliber, validating the mechanical etiology of the deficits. This case is unique in its application of nanostructured SeNP technology to enhance biocompatibility and highlights the importance of distinguishing dynamic compression from static atrophy in TBI recovery.