The Syndrome of the Trephined is a complication that can occur following craniectomy.

Clinical features:

(1) The patient has a history of a craniectomy without cranioplasty.

(2) The scalp flap overlying the bone defect sinks down into the space (possibly due to the effects of atmospheric pressure).

(3) The scalp compresses the brain, which may affect cerebral perfusion and CSF flow.

(4) The patient may have headache, dizziness and neurological deficits (motor, cognitive and/or language).

(5) The patient may show clinical deterioration or a failure to improve.

(6) Cranioplasty usually corrects the cosmetic and neurological problems.

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