下沉皮瓣综合征：危险因素、结局及神经影像在颅骨修补时机中的作用
该回顾性研究纳入166例去骨瓣减压术后行颅骨修补的成人患者，发现SFS的影像学诊断常被遗漏，约30%符合影像学标准者未被报告。神经影像医生识别SFS可使颅骨修补时间缩短一半（中位9天 vs 18天），且不增加术后并发症。独立预测因素包括创伤性损伤、皮瓣直径≥16 cm及中线移位≥8 mm。
要点
- 符合SFS影像学标准者中约30%未被放射科报告，需提高识别意识。
- 创伤性损伤、皮瓣直径≥16 cm、中线移位≥8 mm是SFS独立预测因素。
- 神经影像医生明确诊断SFS可显著缩短颅骨修补等待时间，且不增加并发症。
关键影像表现/征象
- 正式诊断SFS者55例（33.1%），另有23例（13.9%）符合影像学标准但放射科报告未诊断，即78例中30%未被叫诊断。
- 被叫诊断SFS的患者ICU住院时间更长、再次手术次数更多、术后卒中及出血发生率更高。
诊断标准与关键数值
- SFS独立预测因素：创伤性损伤（aOR 3.75）、皮瓣直径≥16 cm（aOR 2.38）、中线移位≥8 mm（aOR 7.81）。
临床应用与阅片要点
- 对去骨瓣减压术后患者，应主动评估皮瓣下沉、中线移位等SFS征象并在报告中明确提示。
- 皮瓣直径≥16 cm或中线移位≥8 mm的创伤性损伤患者属高危，建议重点监测。
- 报告SFS可加速颅骨修补决策，且不增加术后并发症风险。
局限性
- 回顾性单中心设计，样本量有限，结论外推需谨慎。
- 原文未报告影像学标准的具体定义及多因素模型的其他变量。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND AND PURPOSE: Sinking flap syndrome (SFS) is an underrecognized complication of decompressive craniectomy often associated with neurologic decline. We assessed the neuroradiologist's role in identifying SFS, the effect of SFS development on the timing to cranioplasty, and predictive factors for development. We also propose standardized criteria for diagnosis.
MATERIALS AND METHODS: We conducted a retrospective analysis of adults who underwent cranioplasty of ≥5 cm between 2019 and 2024. Radiology reports were reviewed for formal documentation of SFS. Patients meeting imaging criteria but lacking a documented diagnosis were classified as having "uncalled" SFS. Demographics, imaging findings, outcomes, and timing were analyzed.
RESULTS: Among 166 included patients, SFS was formally diagnosed in 55 (33.1%) patients, but 23 (13.9%) others met the radiographic criteria regardless of radiology reports, suggesting that 30% (23/78) of SFS cases went uncalled. Among patients with called SFS, trauma was the most common cause (67.3%), with larger flap diameters (16.0 versus 14.7 cm, P = .03), midline shift of ≥8 mm (P < .001), and neurologic symptoms (80% versus 60%) being more prevalent than in those without called SFS. Patients with called SFS had longer intensive care unit stays, more trips to the operating room, and higher postoperative stroke and hemorrhage rates. Independent predictors of actual SFS development included trauma-induced injury (adjusted OR [aOR, 3.75]), flap diameter, ≥16 cm (aOR, 2.38), and midline shift ≥8 mm (aOR, 7.81). Neuroradiologist-called SFS halved the time to cranioplasty (median 9 versus 18 days, P = .04) without increasing postoperative complications compared with uncalled SFS.
CONCLUSIONS: SFS may be under-recognized, with nearly one-half of patients meeting imaging criteria but only 70% formally diagnosed. A neuroradiologist's recognition of SFS significantly shortens the time to surgery without increasing postoperative complication risks. Early identification can reduce downstream complications common to SFS development. Standardized criteria, greater awareness, and targeted surveillance of high-risk patients can support earlier intervention and improved outcomes.
引用
- Cole KL, Rennert RC, Tenhoeve SA, et al. Sinking Flap Syndrome: Risk Factors, Outcomes, and the Role of Neuroradiology in Cranioplasty Timing. AJNR Am J Neuroradiol. 2026. PMID: 42062036. doi:10.3174/ajnr.A9117
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。