External cranioplasty for the syndrome of the trephined – Case report

Background: The syndrome of the trephined was described in 1939 by Grant and Norcross and is defined as a progressive neurological deterioration after craniectomy. Commonly, it is associated with sinking of the skin near the bone-free area. The symptoms and signs improve after cranioplasty. This report intends to describe an uncommon case of a patient who presented to the hospital with the syndrome of the trephined and was temporarily treated with a plastered helmet. Case description: 45-year old male was submitted to a decompressive craniectomy due to severe traumatic brain injury. After one month, he was diagnosed with the syndrome of the trephined. Once he was in sepsis, cranioplasty could not be done. An alternative treatment was proposed and the patient improved in both clinical and radiological cenarios. Conclusion: The external cranioplasty made with plastered helmet proved to be an effective technique that can be safely applied to patients with the syndrome of the trephined who cannot be promptly treated with surgery.