Decompressive Craniectomy and Hinged Craniotomy for Traumatic Brain Injury: Experience in Two Centers in a Middle-Income Country

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.