Xxiv международная медико-биологическая конференция молодых исследователей Фундаментальная наука и клиническая

Conclusions: 
1. Lack of consensus and criteria defining the optimal 
method of ML. 2. Shifting from the basic 2D measurement to a 3D 
method may require new severity criteria or classifications. 3. The next 
era of researches must involve both the standardization of ML techniques 
and at the same time their introduction into clinical practice.
References:
1. Chen K., Zhai X, Sun K. et al. A narrative review of machine 
learning as promising revolution in clinical practice of scoliosis // Ann Transl 
Med. 2021 Jan; 9(1): 67
 

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V САТЕЛЛИТНЫЙ СИМПОЗИУМ ПО КЛИНИЧЕСКОЙ ПАТОФИЗИОЛОГИИ
TRENDELENBURG’S POSITION IMPROVES SINKING 
BRAIN SYNDROME: A CASE REPORT
Kunić V., MD
Outpatient Clinic Kapela, Bjelovar-Bilogora County Health Center,
Bjelovar, Croatia 
Acad. Supervisor: Prof. Z. Kovač, M.D., Ph.D., Chairman of Dept. 
Key words:
sinking brain, sinking skin flap, Trendelenburg’s position

Introduction.
Sinking brain syndrome (SBS) also referred to as sinking 
skin flap syndrome, syndrome of the trephined or sunken brain and scalp 
flap syndrome, is a rare, yet severe complication of a large decompressive 
craniectomy. It is diagnosed as a sunken skin flap at the craniectomy 
site, paralleled with a patient’s neurological deterioration that improves 
after cranioplasty. The etiopathogenesis of SBS is not fully understood. It 
includes brains and other soft tissue structures' inability to counterbalance 
atmospheric pressure. Physiologically, atmospheric pressure exceeds 
intracranial underpressure, which is, following the craniectomy, directly 
transmitted on the intracranial structures, thus causing the compression 
of the cerebral tissue. Cerebrospinal fluid distribution dynamics are 
altered, and cerebral blood flow is reduced. That excessive pressure on 
the unprotected brain may cause neurological dysfunction and even 
coma and death if paradoxical herniation progresses. A paradoxical 
herniation is a compression-induced deformation. Namely, herniation is 
usually in opposite direction (from inside outwards) and due to increased 
intracranial pressure. In the SBS the opened skull enables the atmospheric 
pressure squeezing of the intracranial soft tissues. It is important to 
promptly reverse the progression of this life-threatening condition. Since 
lowering the intracranial pressure increases the suction force on the brain, 
maneuvers that elevate the intracranial pressure are performed. These 
procedures are hydration, discontinuation of hyperosmolar drainage, and 
Trendelenburg position. Cranioplasty is the long-term treatment and 
prevention procedure of SBS.