• Mrudul M Bhatjiwale, Mohinish G Bhatjiwale, and Salila S Chandorkar.
• Department of Neurosurgery, Narayana Health City, Bengaluru, India. Electronic address: mbhatjiwale@gmail.com.
• World Neurosurg. 2019 Jul 1; 127: 366-369.

BackgroundThe sinking skin flap syndrome, also known as the syndrome of the trephined or the trephination syndrome, occurs in patients who have undergone a decompressive craniectomy. As opposed to this, persistent brain herniation also occurs in patients after a decompressive craniectomy and a cerebrospinal fluid (CSF) drainage procedure is one of the therapies used to reduce it. A continuous lumbar CSF drainage procedure can upset the pressure dynamics of the atmosphere versus intracranial pressures to a point of fatal clinical deterioration and hence needs to be closely monitored.Case DescriptionOur case report speaks of persistent brain herniation in which drainage of CSF led to a trephination syndrome, which was reversed once again, by measures to increase CSF production and intracranial pressure.ConclusionsTimely intervention eventually led to a favorable outcome and avoidance of a catastrophy.Copyright © 2019 Elsevier Inc. All rights reserved.

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