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Syndrome of the Trephined Related to Inflation of a Scalp Tissue Expander

Abstract Syndrome of the Trephined (SoT) is a severe complication following decompressive craniectomy. Urgent cranioplasty fully reverses the neurologic symptoms of SoT. This article presents a recent case of SoT following inflation of a scalp tissue expander. A review of the literature was performed and case details obtained from the electronic medical record. Our patient had a large craniectomy defect following traumatic brain injury. A scalp tissue expander was used before secondary cranioplasty. The patient suffered severe neurologic decline temporally related to tissue expander inflation, which was fully reversed following expander removal and urgent cranioplasty. SoT can be a neurologically devastating complication which can resolve following urgent cranioplasty. To our knowledge, this is the first description of SoT resulting from inflation of a scalp tissue expander. Familiarity with this syndrome is critical for the plastic surgery provider, who may be called upon to assist with these urgent cases.