“Sinking Bone” flap presenting as reversible postural hemiparesis

Abstract

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Complications after Cranioplasty: A Pictorial Narrative with Techniques to Manage and Avoid the Same

“…While most patients will have non-serious complaints such as a subjective fullness of the operative site on getting up from sleep which sinks inward somewhat as the day progresses, abnormal mobility of the implanted bone may cause symptoms and called the "Sinking Bone Syndrome." 20 We have documented a case of reversible postural hemiparesis 21 where there was variation in MCA flow with flap movement [►Fig. 9].…”

“…A flap that is not firmly fixed (as with sutures instead of miniplates and screws) may on occasion move with variations in intracranial pressure (occurring with coughing/sneezing) or with posture too. While most patients will have non-serious complaints such as a subjective fullness of the operative site on getting up from sleep which sinks inward somewhat as the day progresses, abnormal mobility of the implanted bone may cause symptoms and called the “Sinking Bone Syndrome.” 20 We have documented a case of reversible postural hemiparesis 21 where there was variation in MCA flow with flap movement [ Fig. 9 ].…”

“…Neurological deterioration may occur due to disturbances in cerebral metabolism (documented using flurodeoxy glucose positron emission tomography studies) due to decreased cerebral blood flow by the pressure of the flap. 21…”