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Decompressive Craniectomy and Hinged Craniotomy for Traumatic Brain Injury: Experience in Two Centers in a
Carlos A Gamboa-Oñate1,2, Nicolás Rincón-Arias1,2, Matías Baldoncini3
1Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José - Sociedad de Cirugía de Bogotá, Bogotá, Colombia.
Insights
Decompressive craniectomy (DC) and hinge craniotomy (HC) treat traumatic brain injury (TBI). Preoperative pupil condition may guide the choice between DC or HC, impacting patient outcomes.
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.
Objective:
The goal of a decompressive craniectomy (DC) or a hinge craniotomy (HC), is to treat intracranial hypertension and reduce mortality. Traditionally, the decompression procedure has been performed with cranial bone removal. However, decompression and repositioning the cranial bone, named HC, has been presented as an alternative for certain cases. Our objective is to describe the neuroradiological and clinical preoperative factors and outcomes in traumatic brain injury (TBI) cases treated with both techniques in 2 centers in a Middle-Income country.
Methods:
This is a retrospective cross-sectional study of adult patients who underwent decompression surgical treatment for TBI, either with a traditional DC or HC, in 2 centers in Bogotá, Colombia between 2016-2020.
Results:
This study involved 30 cases that underwent HC and 20 that underwent DC. 78% were male with an overall mean age of 50.2 years. 66% cases had traumatic subarachnoid hemorrhage (tSAH) and 60% had evidence of acute subdural hematoma ≥10 mm in thickness. The overall mortality rate during hospitalization was 20%. Preoperative pupil impairment differences between the 2 groups were statistically significant (p=0.026).
Conclusion:
This study reveals that using a traditional DC or HC depends on the neurosurgeon's intraoperative case-by-case assessment according to the intraoperative brain's vitality and the presence of diffuse edema in the brain parenchyma at the time of surgical closure. Each case requires an individualized evaluation before and during surgery. The preoperative pupil condition can serve as a marker for HC or DC selection.
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