Asymmetric optic nerve sheath diameter as an outcome factor following cranioplasty in patients harboring the 'syndrome of the trephined'

Decompressive craniectomy (DC) is gaining an increasing role in the neurosurgical treatment of intractable intracranial hypertension, but not without complications. A rare complication is the “syndrome of the trephined” (ST). It occurs when the forces of gravity overwhelm intracranial pressures, leading the brain to become sunken. Objective To determine the usefulness of asymmetric optic nerve sheath diameter (ONSD) as an outcome factor after cranioplasty. Method We followed-up 5 patients submitted to DC and diagnosed with ST. All were submitted to brain MRI to calculate the ONSD. Results Only two patients presented an asymmetric ONSD, being ONSD larger at the site of craniectomy. Surprisingly these patients had a marked neurological improvement after cranioplasty. They became independent a week after and statistically earlier than others. Conclusion It is presumed that the presence of an asymmetric ONSD in trephined patients is an independent factor of good outcome after cranioplasty.

Bibliographic Details

Main Authors:	Araujo Junior,Antonio Santos de, Arlant,Pedro Alberto, Salvestrini Jr,Arnaldo, Altieri,Carlos Eduardo, Santos,Jasper Guimaraes, Pinto,Lauro Figueira, Fazzito,Mirella Martins, Lee,Hae Won, Godoy,Luis Felipe de Souza
Format:	Digital revista
Language:	English
Published:	Academia Brasileira de Neurologia - ABNEURO 2013
Online Access:	http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2013001300963
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