Cranioplasty, frequently utilizing autologous bone grafts, is a critical surgical intervention targeting the management of “syndrome of the trephined” in patients who have previously undergone craniectomy. This syndrome manifests as a spectrum of clinical symptoms, including persistent headaches, cognitive impairments, motor deficits, and diminished neurological function, which are primarily associated with compromised cranial vault integrity and resultant disturbances in intracranial pressure homeostasis and cerebrospinal fluid dynamics. Cranioplasty restores skull protection and intracranial pressure balance, which has been shown to contribute significantly to neurological improvements, including the reduction of neuropsychological deficits, better control of seizure activity, and partial mitigation of cerebral atrophy. This procedure thus plays a crucial role in enhancing cognitive and functional recovery in post-craniectomy patients. This report details the neuropsychological and functional assessments conducted pre- and post-operatively on a 27-year-old male patient who underwent cranioplasty after a prior craniectomy, which was necessitated by a subdural hemorrhage caused by an explosive incident, resulting in significant shrapnel wounds.

A cranioplastia, frequentemente utilizando enxertos ósseos autólogos, é uma intervenção cirúrgica crítica que visa o tratamento da "síndrome do trefinado" em pacientes previamente submetidos a craniectomia. Essa síndrome se manifesta como um espectro de sintomas clínicos, incluindo cefaleias persistentes, comprometimentos cognitivos, déficits motores e diminuição da função neurológica, que estão principalmente associados ao comprometimento da integridade da calota craniana e aos consequentes distúrbios na homeostase da pressão intracraniana e na dinâmica do líquido cefalorraquidiano. A cranioplastia restaura a proteção craniana e o equilíbrio da pressão intracraniana, o que demonstrou contribuir significativamente para melhorias neurológicas, incluindo a redução de déficits neuropsicológicos, melhor controle da atividade convulsiva e mitigação parcial da atrofia cerebral. Portanto, esse procedimento desempenha um papel crucial no aprimoramento da recuperação cognitiva e funcional em pacientes pós-craniectomia. Este relatório detalha as avaliações neuropsicológicas e funcionais realizadas pré e pós-operatórias em um paciente do sexo masculino de 27 anos, submetido a cranioplastia após uma craniectomia prévia, necessária devido a uma hemorragia subdural causada por um incidente explosivo, resultando em ferimentos significativos por estilhaços.

JQ, AE, RK, MA, NS: Literature search, manuscript preparation, revised manuscript, submission, and corresponding author. Literature search, preparation of the manuscript, revision of the manuscript; initiated, conceptualized, and organized the research; supervised and critically reviewed the manuscript; and finalized the manuscript. All authors read and approved of the final manuscript.

Received: 08 February 2025

Accepted: 22 May 2025

Article published online:
16 July 2025

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