1011 - Rehabilitation after Syndrome of the Trephined

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

RE

Rosalie Ellis, DO

Resident
MossRehab
Philadelphia, Pennsylvania, United States

Co-Author(s)

CB

Chase Bauer, DO

resident
Jefferson Moss Magee
Philadelphia, Pennsylvania, United States
MM

Michael Marino, MD

Attending Physician
Jefferson Moss Magee Rehabilitation Hospital
Elkins Park, Pennsylvania, United States

Submitter(s)

RE

Rosalie Ellis, DO

MossRehab
Philadelphia, Pennsylvania, United States

Case Diagnosis: Syndrome of the Trephined

Case Description: A 28-year-old male with a history of severe traumatic brain injury status post decompressive hemicraniectomy was noted in his outpatient speech therapy to have difficulty completing the orientation log, despite scoring 21/30 the week prior. He also had a decline in his gait. Due to concern for syndrome of the trephined (SoT), and the patient was treated with cranioplasty and admitted to acute inpatient rehabilitation for two weeks. The patient’s orientation log score went from 10/30 upon rehabilitation admission to 23/30 four days later. Similarly, the patient required minimal assistance in ambulation and moderate assistance in most activities of daily living upon rehabilitation admission; he progressed to independence in ambulation and activities of daily living upon discharge.

Discussions: SoT, outside of the surgical community, is a rare, poorly understood, and devastating surgical complication following decompressive craniectomy that can present around 4 months following surgery. Patients may demonstrate motor and motor deficits, seizure, dizziness, catatonia, aphasia and decreased wakefulness that can progress to death. The most common indication for craniectomy were traumatic brain injury (43%), tumor resection (23%), intracerebral hemorrhage (11%) and subarachnoid hemorrhage (2%). Treatment is urgent cranioplasty and can fully reverse the neurological symptoms, thus a better awareness of SoT is critical for all rehabilitation providers to be aware of.

Conclusions: This case demonstrated a typical case of SoT, and its resolution following treatment. It is important for clinicians to be familiar with SoT, as early recognition of symptoms and treatment with cranioplasty is associated with improved outcomes. Additionally, clinicians also should expect significant neurological improvement in the rehabilitation course after cranioplasty.