Repository logo
 

Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review.

Accepted version
Peer-reviewed

No Thumbnail Available

Type

Article

Change log

Authors

Layard Horsfall, Hugo 
Mohan, Midhun 
Devi, B Indira 
Adeleye, Amos O 
Shukla, Dhaval P 

Abstract

Hinge craniotomy (HC) is a technique that allows for a degree of decompression whilst retaining the bone flap in situ, in a 'floating' or 'hinged' fashion. This provides expansion potential for ensuing cerebral oedema whilst obviating the need for cranioplasty in the future. The exact indications, technique and outcomes of this procedure have yet to be determined, but it is likely that HC provides an alternative technique to decompressive craniectomy (DC) in certain contexts. The primary objective was to collate and describe the current evidence base for HC, including perioperative parameters, functional outcomes and complications. The secondary objective was to identify current nomenclature, operative technique and operative decision-making. A scoping review was performed in accordance with the PRISMA-ScR Checklist. Fifteen studies totalling 283 patients (mean age 45.1 and M:F 199:46) were included. There were 12 different terms for HC. The survival rate of the cohort was 74.6% (n = 211). Nine patients (3.2%) required subsequent formal DC. Six studies compared HC to DC following traumatic brain injury (TBI) and stroke, finding at least equivalent control of intracranial pressure (ICP). These studies also reported reduced rates of complications, including infection, in HC compared to DC. We have described the current evidence base of HC. There is no evidence of substantially worse outcomes compared to DC, although no randomised trials were identified. Eventually, a randomised trial will be useful to determine if HC should be offered as first-line treatment when indicated.

Description

Keywords

Decompressive craniectomy, Neurosurgery, Stroke, Traumatic brain injury, Brain Injuries, Traumatic, Craniotomy, Decompression, Surgical, Humans, Neurosurgical Procedures, Stroke, Surgical Flaps

Journal Title

Neurosurg Rev

Conference Name

Journal ISSN

0344-5607
1437-2320

Volume Title

43

Publisher

Springer Science and Business Media LLC

Rights

All rights reserved
Sponsorship
Medical Research Council (G0601025)
European Commission (602150)
NIHR Global Health Research Group on Neurotrauma