The Syndrome of Trephined: Role of the Anesthesiologists in Overcoming the Physiological Changes

A 58-year-old male with a skull defect came to the Emergency Department with a history decompressive craniectomy caused by subdural hematoma. 5 months after the surgery he came back with general weakness. His consciousness progressively decreased to GCS 4 (E2VxM2). MRI showed brain edema and midline shift to the right side suggesting a Syndrome of the Trephined. He underwent autograft cranioplasty to close the defect. After the surgery, the patient’s general condition improved significantly. The consciousness and limb weakness began to improve, he was discharged after 3 days. The clinical spectrum of Syndrome of the Trephined shows symptoms of increased intracranial pressure such as headache, decreased consciousness, and other neurological deficits. Anesthesiologists hold a vital role in managing the physiology changes, deciding the most suitable anesthesia technique, and choosing the right medication to overcome this physiological changes. Management in these patients focused on reducing the compressive effects of atmospheric pressure on brain tissue. Cranioplasty is the definitive therapy for Syndrome of the Trephined.