{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T07:40:24Z","timestamp":1760082024203,"version":"build-2065373602"},"reference-count":16,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nSinking flap syndrome (SFS) is a well-documented but typically delayed complication of decompressive craniectomy (DC). Early-onset SFS, especially within hours of surgery, is extremely rare and may pose diagnostic and therapeutic challenges. In this report, we describe a unique case of SFS occurring just 2 h after DC in the context of an intraoperative air embolism and prolonged cardiopulmonary resuscitation, underscoring the impact of acute hemodynamic disturbances on SFS pathogenesis.<\/jats:p>\n<\/jats:sec>\n\nCase Description: <\/jats:title>\nWe present the case of an 84-year-old female with a history of hypertension and chronic aspirin use who underwent DC for a left temporo-parietal acute subdural hematoma. Intraoperatively, the patient experienced cardiac arrest requiring resuscitation. Postoperatively, she was intubated for 1 h and then extubated. At postoperative h 2, the scalp flap was observed to be sunken. On regaining consciousness, she was found to have new-onset right hemiplegia. Once hemodynamically stabilized, cranial computed tomography was performed at postoperative h 6 and confirmed SFS. Emergent cranioplasty was performed using the autologous bone flap. Neurological improvement was noted in the following days, and the patient was discharged with partial motor recovery and active rehabilitation plans.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nAlthough usually delayed, SFS can present as early as 2 h post-DC, particularly in the setting of intraoperative hypotension and cerebral hypoperfusion. Prompt recognition and intervention are crucial to prevent long-term neurological deficits.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_500_2025","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T07:05:23Z","timestamp":1760079923000},"page":"428","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemiplegia and sinking flap syndrome within 2 hours of decompressive craniectomy: A rare case following intraoperative cardiac arrest"],"prefix":"10.25259","volume":"16","author":[{"given":"Amin","family":"Charehsaz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatih Bera","family":"Gurtas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Berker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"10.25259\/SNI_500_2025\/ref-1","first-page":"e46501","article-title":"Outcome of early cranioplasty in trephine syndrome or paradoxical brain herniation: A case report and literature review","volume":"17","author":"Alwadei","year":"2025","journal-title":"Cureus"},{"key":"10.25259\/SNI_500_2025\/ref-2","doi-asserted-by":"crossref","first-page":"314","DOI":"10.3109\/02688697.2015.1012047","article-title":"Sinking skin flap syndrome (or syndrome of the trephined): A review","volume":"29","author":"Annan","year":"2015","journal-title":"Br J Neurosurg"},{"key":"10.25259\/SNI_500_2025\/ref-3","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1227\/NEU.0000000000001366","article-title":"Syndrome of the trephined: A review","volume":"79","author":"Ashayeri","year":"2016","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_500_2025\/ref-4","first-page":"6682310","article-title":"Sinking skin flap syndrome following posttraumatic hydrocephalus","volume":"2021","author":"Bitsios","year":"2021","journal-title":"Case Rep Neurol Med"},{"key":"10.25259\/SNI_500_2025\/ref-5","doi-asserted-by":"crossref","first-page":"CASE23579","DOI":"10.3171\/CASE23579","article-title":"Vacuum-assisted scalp repositioning: A novel temporizing approach to acute sinking skin flap syndrome. Illustrative cases","volume":"6","author":"Courville","year":"2023","journal-title":"J Neurosurg Case Lessons"},{"key":"10.25259\/SNI_500_2025\/ref-6","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s10143-019-01148-7","article-title":"Sinking flap syndrome revisited: The who, when and why","volume":"43","author":"Di Rienzo","year":"2020","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_500_2025\/ref-7","doi-asserted-by":"crossref","first-page":"4917","DOI":"10.12998\/wjcc.v10.i15.4917","article-title":"Paradoxical herniation after decompressive craniectomy provoked by mannitol: A case report","volume":"10","author":"Du","year":"2022","journal-title":"World J Clin Cases"},{"key":"10.25259\/SNI_500_2025\/ref-8","first-page":"24","article-title":"Sinking bone flap with ipsilateral hemiparesis: The neurosurgical puzzle solved","volume":"39","author":"El-Ghandour","year":"2024","journal-title":"Egypt J Neurosurg"},{"key":"10.25259\/SNI_500_2025\/ref-10","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.3171\/2009.3.FOCUS0962","article-title":"Complications of cranioplasty following decompressive craniectomy: Analysis of 62 cases","volume":"26","author":"Gooch","year":"2009","journal-title":"Neurosurg Focus"},{"key":"10.25259\/SNI_500_2025\/ref-11","doi-asserted-by":"crossref","first-page":"79","DOI":"10.25259\/SNI-235-2019","article-title":"Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report","volume":"10","author":"Hiruta","year":"2019","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_500_2025\/ref-12","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1089\/neu.2010.1612","article-title":"Long-term complications of decompressive craniectomy for head injury","volume":"28","author":"Honeybul","year":"2011","journal-title":"J Neurotrauma"},{"key":"10.25259\/SNI_500_2025\/ref-13","doi-asserted-by":"publisher","DOI":"10.25259\/CRCR_82_2024","article-title":"Sinking skin flap syndrome: A rare complication following a craniectomy","author":"Joshi","year":"2024","journal-title":"Case Rep Clin Radiol"},{"key":"10.25259\/SNI_500_2025\/ref-14","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1080\/01616412.2024.2448632","article-title":"Revisiting sinking skin flap syndrome: A series of case reports and literature review on cranioplasty with PEEK implants","volume":"47","author":"Kang","year":"2025","journal-title":"Neurol Res"},{"key":"10.25259\/SNI_500_2025\/ref-15","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1186\/s13256-024-04963-9","article-title":"Sinking skin flap syndrome exacerbated by ventriculopleural shunt placement: A case report","volume":"18","author":"Liang","year":"2024","journal-title":"J Med Case Rep"},{"key":"10.25259\/SNI_500_2025\/ref-16","first-page":"e24458","article-title":"Sinking skin flap syndrome after decompressive hemicraniectomy in a patient with calvarial multiple myeloma who underwent a lumbar puncture: A case report","volume":"14","author":"Tonini","year":"2022","journal-title":"Cureus"},{"key":"10.25259\/SNI_500_2025\/ref-17","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3171\/jns.2000.93.1.0053","article-title":"The Influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism","volume":"93","author":"Winkler","year":"2000","journal-title":"J Neurosurg"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/hemiplegia-and-sinking-flap-syndrome-within-2-hours-of-decompressive-craniectomy-a-rare-case-following-intraoperative-cardiac-arrest\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/hemiplegia-and-sinking-flap-syndrome-within-2-hours-of-decompressive-craniectomy-a-rare-case-following-intraoperative-cardiac-arrest\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T07:05:28Z","timestamp":1760079928000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/hemiplegia-and-sinking-flap-syndrome-within-2-hours-of-decompressive-craniectomy-a-rare-case-following-intraoperative-cardiac-arrest\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,10]]},"references-count":16,"alternative-id":["10.25259\/SNI_500_2025"],"URL":"https:\/\/doi.org\/10.25259\/sni_500_2025","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2025,10,10]]},"article-number":"428"}}