Hinged craniotomy [Neurosurgery Wiki]

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====== Hinged craniotomy ======

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A hinged [[craniotomy]] is a [[neurosurgical technique]] in which a [[bone flap]] is partially reattached to the [[skull]] using hinges (such as [[suture]]s, [[plate]]s, or even [[absorbable]] [[material]]s) instead of completely fixing it back into place with rigid [[fixation]]. This allows for controlled expansion of the [[cranial vault]] postoperatively while still providing some protection for the underlying brain.

===== Indications =====

Malignant brain tumors (e.g., glioblastoma) that may cause postoperative [[swelling]].

[[Decompressive craniectomy]] alternative: In patients who may need future reoperations or swelling relief.

Pediatric cases (e.g., craniosynostosis) where skull growth is a factor.

Traumatic brain injury (TBI): When there is concern about brain swelling but a full decompressive craniectomy is not necessary.

===== Technique =====

[[Skin Incision]] and Bone Flap Creation: A standard craniotomy is performed, but instead of removing the bone completely, one side remains attached as a hinge (commonly at the base or one side).

Hinge Placement: The bone flap is secured with sutures, mini plates, or bioabsorbable materials, allowing controlled movement.

Closure: The skin and dura are closed to allow for potential postoperative expansion.

Follow-up: If needed, the flap can be repositioned or removed later.

===== Advantages =====

Reduces the risk of [[syndrome of the trephined]] seen in large craniectomies.

Provides some protection compared to a full [[craniectomy]].

Allows for [[brain swelling]] accommodation while avoiding a second major surgery to replace the bone flap.

Can improve cosmesis and reduce complications related to artificial [[implant]]s.

===== Complications =====

[[Hinged craniotomy complications]]