A Novel Method for the Temporary Treatment of Sunken Flap Syndrome: A Presentation of 3 Cases

BACKGROUND AND IMPORTANCE: Sunken flap syndrome (SFS) is a neurological decline that results from paradoxical brain shift following decompressive hemicraniectomy. It is thought to arise from a gradient between atmospheric and intracranial pressure and can cause neurological morbidity if not surgically corrected. In most cases, this involves autologous or synthetic cranioplasty. However, in select patient populations, this is not possible—either because of recent infection, availability of cranioplasty implant, anticoagulant use, or other patient-specific factors. CLINICAL PRESENTATION: In this case report, we present 3 patients with SFS who could not undergo cranioplasty due to a recent surgical site infection. Instead, their SFS was managed nonoperatively with a makeshift “external cranioplasty” that resulted in significant improvement in their midline shift and mental status. CONCLUSION: We believe this fast, economical approach can be applied to future patients with SFS who are unable to undergo surgical intervention.