What is sinking skin flap syndrome after craniectomy?

Sinking skin flap syndrome, also called syndrome of the trephined, is a complication that can happen after a craniectomy. A craniectomy is surgery to remove part of the skull. After part of the skull is removed, changes in pressure can cause the skin over the opening to sink and press on the brain. Changes in pressure also can affect the brain even when the skin doesn't appear sunken.

If you have sinking skin flap syndrome, you may have weakness or other issues with movement, trouble walking, headaches, dizziness, fatigue or changes in thinking. You may have trouble paying attention or thinking, remembering, or concentrating. Some people have symptoms that get worse when they sit or stand and improve when they lie down.

The main treatment for sinking skin flap syndrome is cranioplasty. This is surgery to repair the opening in the skull. Cranioplasty may help restore blood flow, fluid movement and pressure around the brain. It also can improve movement and thinking in people with sinking skin flap syndrome.

If cranioplasty can't happen right away, the care team may use temporary treatments to help with symptoms. For example, changing your position may help reduce pressure on the brain. These treatments may help until you have cranioplasty. If you have symptoms that you're concerned about or questions about what restrictions you have, reach out to your surgical team.