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Updated: Jul 15, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
In situ hinge craniectomy
1Department of Neurosurgery, Weill Cornell Medical College, New York, New York, USA. k@gyrus.cc
Objective:
To describe an optional method for performing decompressive craniectomy using in situ hinge craniectomy technique in patients with traumatic brain injury and stroke.
Methods:
Sixteen patients underwent surgery for treatment of presenting pathology followed by the placement of hinge craniectomy. The technique is detailed.
Results:
Six patients with traumatic head injury and 10 with stroke underwent treatment of their primary pathologies with subsequent hinge craniectomy. Of these patients, more than half underwent refixation of the hinge in a minor procedure after recovery. No patient had complications related to this technique and none required further cranial decompression. In patients with intracranial pressure monitoring, all displayed values in the normal range.
Conclusion:
In this limited study, in situ hinge craniectomy proved useful in the treatment of patients experiencing stroke or traumatic brain injury. This procedure has the potential to eliminate the additional second incision to explant the bone flap or the refrigeration storage of the bone flap. Also, the second operation to restore the cranial contour by reimplanting the bone flap or by the creation of a cranioplasty with artificial material would not be necessary.
