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Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review
Hugo Layard Horsfall1,2, Midhun Mohan1,2, B Indira Devi2,3
1Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
Neurosurgical Review
|November 13, 2019
Summary
Hinge craniotomy (HC) offers a viable alternative to decompressive craniectomy (DC), showing comparable intracranial pressure control and fewer complications. Further randomized trials are needed to establish HC as a first-line treatment for conditions like traumatic brain injury.
Area of Science:
- Neurosurgery
- Surgical Techniques
- Critical Care Medicine
Background:
- Hinge craniotomy (HC) is a neurosurgical technique for brain decompression, retaining the bone flap to allow for cerebral edema expansion.
- This method potentially avoids the need for future cranioplasty.
- Current indications, techniques, and outcomes for HC require further definition.
Purpose of the Study:
- To collate and describe the existing evidence base for hinge craniotomy.
- To detail perioperative parameters, functional outcomes, and complications associated with HC.
- To identify current nomenclature, operative techniques, and decision-making processes for HC.
Main Methods:
- A scoping review was conducted following the PRISMA-ScR Checklist.
- Fifteen studies involving 283 patients were included in the analysis.
- Data on patient demographics, outcomes, and complications were extracted and synthesized.
Main Results:
- Twelve different terms were identified for hinge craniotomy.
- The overall survival rate was 74.6%, with 3.2% requiring subsequent decompressive craniectomy.
- Studies comparing HC to DC for traumatic brain injury and stroke indicated equivalent intracranial pressure control and lower complication rates for HC.
Conclusions:
- Hinge craniotomy presents a promising alternative to decompressive craniectomy with comparable efficacy and improved safety profile.
- No randomized trials were identified, highlighting the need for high-quality evidence.
- Further research, particularly randomized controlled trials, is essential to determine the optimal role of HC in neurosurgical practice.
