Decompressive Craniectomy and Hinged Craniotomy for Traumatic Brain Injury: Experience in Two Centers in a...

Area of Science:

• Neurosurgery
• Trauma Surgery
• Critical Care

Background:

• Decompressive craniectomy (DC) and hinge craniotomy (HC) are surgical interventions to manage intracranial hypertension and reduce mortality in traumatic brain injury (TBI).
• Traditional DC involves bone removal, while HC repositions the cranial bone, offering an alternative in specific cases.

Purpose of the Study:

• To describe preoperative neuroradiological and clinical factors influencing the selection of DC versus HC.
• To evaluate outcomes associated with both surgical techniques in TBI patients.

Main Methods:

• Retrospective cross-sectional study.
• Analysis of adult TBI patients undergoing DC or HC between 2016-2020 in two centers in Bogotá, Colombia.
• Involved 30 HC and 20 DC cases.

Main Results:

• The study included 50 TBI patients (78% male, mean age 50.2 years).
• Common findings included traumatic subarachnoid hemorrhage (66%) and acute subdural hematoma (60%).
• Overall in-hospital mortality was 20%, with statistically significant differences in preoperative pupil impairment between DC and HC groups (p=0.026).

Conclusions:

• The choice between DC and HC is based on intraoperative assessment of brain vitality and edema.
• Individualized preoperative and intraoperative evaluation is crucial for surgical decision-making.
• Preoperative pupil status can be a predictive marker for selecting between HC and DC.