Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension

Ibrahim Omerhodzic; Almir Dzurlic; Bekir Rovcanin; Kresimir Rotim; Amel Hadzimehmedagic; Adi Ahmetspahic; Zlatan Zvizdic; Nermir Granov; Enra Suljic

doi:10.1016/j.bas.2023.101758

Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension

Brain Spine. 2023 May 19:3:101758. doi: 10.1016/j.bas.2023.101758. eCollection 2023.

Authors

Ibrahim Omerhodzic¹, Almir Dzurlic¹, Bekir Rovcanin¹, Kresimir Rotim², Amel Hadzimehmedagic³, Adi Ahmetspahic¹, Zlatan Zvizdic⁴, Nermir Granov³, Enra Suljic⁵

Affiliations

¹ Department of Neurosurgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
² Department of Neurosurgery, Clinical Hospital Center Sisters of Mercy, Zagreb, Croatia.
³ Department of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
⁴ Department of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
⁵ Department of Neurology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.

Abstract

Introduction: Decompressive craniectomy (DC) can save brain tissue, but unfortunately it has many limitations and complications. Hinge craniotomy (HC), as less aggressive method seems to be adequate alternative not only to DC but also to conservative treatment.

Research question: Presentation of the results of modified surgical techniques of cranial decompression and comparing with more and less aggressive medical options.

Material and methods: A prospective clinical study was conducted during 86 months. Comatose patients who suffered refractory intracranial hypertension (RIH) were treated. Altogether, 137 patients have been evaluated. The final outcome of all patients in the study was evaluated after 6 months.

Results: Both surgical options resulted in adequate control of intracranial pressure (ICP). HC method was shown to have the lowest probability of worsening from a prior state of relative stability.

Discussion and conclusion: There was no statistically significant difference between methods to treatment of DC or HC, meaning the final outcome of patients treated in any manner. There was similar rate of early and late complications.

Keywords: Decompressive craniectomy; Hinge craniotomy; ICP; Refractory intracranial hypertension; TBI.