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Sinking skin flap syndrome in the multi-trauma patient: a paradoxical management to TBI post craniectomy [Case Report]

Hakmi, Hazim; Joseph, D'Andrea K; Sohail, Amir; Tessler, Lee; Baltazar, Gerard; Stright, Adam
Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported in trauma patients. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients' head, diuresis and hyperventilation. However, after craniectomy for trauma, a partially boneless cranium may be compressed by the higher atmospheric pressure, that intracranial pressure rises to dangerous levels. For such cases, paradoxical supportive management with intravenous fluid infusion, and reverse Trendelenburg positioning, is used to counteract the higher atmospheric pressure, as a bridge to definitive treatment with cranioplasty. These steps constitute an urgent and easily applied intervention to reduce further neurological deterioration, of which every trauma healthcare provider should be aware.
PMCID:7303104
PMID: 32595925
ISSN: 2042-8812
CID: 4807052

Advanced MRI for brain tumors: a neurosurgical perspective

Golfinos, John G; Tessler, Lee E; Kelly, Patrick J
This paper discusses the modern neurosurgeon's use of advanced magnetic resonance imaging in pre-operative and perioperative planning. The effect of advanced imaging on the risk and benefit analysis of surgery is discussed in particular
PMID: 15627007
ISSN: 0899-3459
CID: 56069