There is no consistent literature about the complications of hinged craniotomy. In particular, there are no reported cases of contralateral subdural effusion (CSE) after HC. Kuptsov et al. present a case of a 55-year-old man who developed CSE after a hinged craniotomy (HC) for intracranial hypertension.
The subdural effusion was managed in a stepwise manner:
He showed clinical deterioration (GCS 7), and imaging (CT and MRI) confirmed a contralateral subdural effusion.
A burr hole drainage was performed to relieve the effusion.
This provided temporary relief, but symptoms recurred within 72 hours.
The burr hole was reopened, and the subdural effusion was drained again.
Additionally, the bone flap was fixated with titanium plates to prevent further effusion formation and restore normal intracranial pressure dynamics.
After the second surgery, the patient showed clinical improvement and was transferred to a neurorehabilitation unit 1).
A 63-year-old man experienced drowsiness (Glasgow coma scale score 13) after a fall that resulted in head trauma. Brain CT revealed a subdural haematoma at the right fronto-temporo-parietal region with a midline shift to the left. Craniectomy for evacuation of the subdural haematoma was performed immediately. A delayed intracerebral haematoma with mass effect in the right frontotemporal region developed later and was removed in a second operation. Although the patient's neurological status improved postoperatively, gradual deterioration was observed during the follow-up period. Contralateral SDG with a midline shift to the right was noted in a follow-up brain CT scan. The patient's condition improved after drainage of the SDG and he was discharged 1 week later 2)