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Underdiagnosis of syndrome of trephined in patients undergoing cranioplasty
Taborah Zaramo B.S., Hunter Stecko B.S, Kerry-Ann S. Mitchell MD-PhD
The Ohio State University Department of Plastic and Reconstructive Surgery
2023-02-10
Presenter: Taborah Zaramo
Affidavit:
The project is orginal work
Director Name: Gregory D. Pearson, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
INTRODUCTION:
Syndrome of the trephined (SoT) is the neurologic derangement that develops when a large segment of the skull is removed in decompressive craniectomy for severe brain insults such as traumatic brain injury, strokes, or intracranial infection. These derangements markedly improve or resolve after the defect is repaired with a cranioplasty procedure. Therefore, it critical that patients with skull defects be referred for reconstruction in a timely manner. We aimed to assess the frequency of SoT in patients undergoing cranioplasty and evaluate whether SoT was diagnosed.
METHODS:
Retrospective chart review was performed on 113 patients undergoing 172 cranioplasty between 2014-2021. SoT was defined as ≥2 points of improvement in Activity Measure for Post-Acute Care (AM-PAC) score 3-7 days after cranioplasty. If a patient met criteria for SoT charts were investigated for mention or diagnosis of SoT. Paired sample t-test and Wilcoxon signed ranked test was performed to determine significance.
RESULTS:
Of the seventy-three patients seen by occupational/physical therapist after cranioplasty. 24 patients met the criteria for SoT with average improvement in AM-PAC score of 4 points (p=0.0125). The most significant improvement in score occurred within 3.6 days (
CONCLUSION:
These results suggest underdiagnosis of SoT in patients with large size skull defects. It is important for surgeons recognize and diagnose SoT since earlier cranioplasty may be warranted, with utilization of multidisciplinary approach to improve patient outcomes.
