"Syndrome of the Sinking Skin-Flap" Secondary to the Ventriculoperitoneal Shunt after Craniectomy

The syndrome of the sinking skin flap was introduced to explain the phenomenon of neurological deterioration after decompressive craniectomy. A 37-year-old man was admitted with acute subdural hematoma and traumatic intraparenchymal hematoma. After decompressive craniectomy, the patient suffered from hydrocephalus for which a ventriculoperitoneal (V-P) shunt was inserted. Following this procedure, the depression of the skin flap became remarkable and his mentation was deteriorated. The patient recovered uneventfully after temporary elevating of valve pressure and cranioplasty. We present a patient who was successfully managed with elevation of valve pressure and cranioplasty for the syndrome of the sinking scalp flap with review of a pertinent literature.

Is Transcranial Doppler Ultrasonography Old-fashioned?: One Institutional Validity Study

Objective: The purpose of this study is to investigate the correlation between various transcranial Doppler (TCD) ultrasonography parameters and clinical vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Methods: This study enrolled 40 patients presented with aneurysmal SAH between September 2006 and August 2007. We measured differences of mean blood flow velocity (BFVm), highest systolic blood flow velocity (BFVh), and Lindegaard ratio (LR) in the middle cerebral artery on TCD examination. These parameters were evaluated for correlation with clinical vasospasm by univariate analysis and the receiver operating characteristic analysis. Results: Twelve patients (30%) developed clinical vasospasm. The best TCD parameters for the detection of clinical vasospasm were revealed to be differences of BFVm, BFVh, and LR values between 1st TCD test and 3rd TCD (7 cm/s, 11.5 cm/s, 0.45 respectively). The positive predictive value of any one of three parameters was 60% and the negative predictive value was 100%. Conclusion: TCD is still considered a useful tool for screening clinical vasospasm. To confirm the predictive value of the above parameters, further prospective study will be needed.