Syndrome of the trephined following burr hole surgery, decompressive craniectomy/cranioplasty, or craniotomy: contemporary vision from a military neurosurgery department

The syndrome of the trephined (ST, 1939) described headaches, scar discomfort, and anxiety following cranial surgery. The sinking skin flap syndrome (1977) described neurological worsening after decompressive craniectomy (DC) and immediate improvement following cranioplasty (CP). They have been mistakenly confused with the other since 1984. The aim was to describe the ST. Symptoms were screened among 20 chronic subdural hematome (CSDH) patients operated on by neurosurgeon-1, and compared to (1) DC-CP patients operated on by neurosurgeon-1, (2) any craniotomy patients followed-up by neurosurgeon-1, and (3) 20 randomly selected CSDH operated on by other neurosurgeons from the same department. Trephined syndrome occured in 69.6% of neurosurgeon-1 CSDH at short-term (2.4 months), and 30% at long-term (17.5 months). It was comparable to 35% ST rate after other neurosurgeons CSDH (20.2 months). ST was observed in 1 out of 3 long-term DC-CP patients, and it was spontaneously reported by 1 craniotomy patient during outpatient consult. Most common neurological symptoms included headaches, asthenia/tireness, and dizziness, scar sensations included pain and itching, feelings included trauma apprehension and anxiety. We did no identify any significant risk factor for developing ST among revision surgery, type of cranial surgery, blood thinners, middle meningeal artery embolization, surgeon, type of anesthesia, and ASA score. We observed significant resolution of ST over time (p = 0.014), one third of patients remaining symptomatic in the long-term, though. ST symptoms in a contemporary cohort are comparable with its original description. ST concerns approximately 30% of CSDH patients, but can also be encountered after DC-CP or craniotomy. Symptoms tend to resolve in two-third of cases.