Sinking skin flap syndrome visualized by upright computed tomography

Keisuke Yoshida, Masahiro Toda, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Hirokazu Fujiwara, Kenzo Kosugi, Mariko Fukumura, Kazunari Koike, Satoshi Takahashi, Kazunari Yoshida, Masahiro Jinzaki

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. Upright computed tomography (CT) before cranioplasty showed a remarkable shift of the brain compared to supine CT. After cranioplasty, both symptoms and brain shift on CT resolved. Upright CT enables detection and objective evaluation of paradoxical herniation and midline shift that is not obvious on supine imaging modalities. Clinicians need to be aware of positional brain shift in postcraniectomy patients.

Original languageEnglish
Pages (from-to)1825-1828
Number of pages4
JournalActa Neurochirurgica
Issue number8
Publication statusPublished - 2020 Aug 1


  • Craniectomy
  • Cranioplasty
  • Sinking skin flap syndrome
  • Syndrome of the trephined
  • Upright CT

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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