What does this research mean for the field?

Hinge craniotomy offers comparable mortality and functional outcomes to decompressive craniectomy, with a reduced risk of hydrocephalus and a possible benefit in seizure incidence. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This analysis aims to determine if hinge craniotomy (HC) achieves outcomes similar to decompressive craniectomy (DC) for elevated intracranial pressure.

March 14, 2026Journal of Neurosciences in Rural Practice0 citationsOpen Access

Surgical approaches to cerebral decompression: A meta-analysis of hinge craniotomy and decompressive craniectomy

SMSysban Soofi MohammedChrist University MJMini JayanChrist University DSDhaval P. ShuklaNational Institute of Mental Health and Neurosciences

Key Points

This analysis aims to determine if hinge craniotomy (HC) achieves outcomes similar to decompressive craniectomy (DC) for elevated intracranial pressure.
Systematic search of PubMed for relevant studies
Inclusion of non-infant patients undergoing HC or DC
Outcomes assessed: Glasgow Outcome Scale scores, mortality, complications, and postoperative ICP
Data pooled using random-effects models to analyze effects
Twelve studies with 663 patients showed no significant differences in favourable GOS scores between HC and DC at discharge and six months.
Mortality rates were similar for both HC and DC in-hospital and at follow-up.
HC showed reduced risk of hydrocephalus compared to DC, with a risk ratio of 0.48.
There was a non-significant reduction in seizures with HC compared to DC.

Abstract

Objectives: To assess whether hinge craniotomy (HC) offers outcomes comparable to decompressive craniectomy (DC) regarding mortality, functional recovery, complications (hydrocephalus and seizure incidence) and postoperative intracranial pressure (ICP). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. Materials and Methods: A systematic search of PubMed and a relevant scoping review were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020. Studies comparing HC with DC in non-infant patients treated for elevated ICP were included. Outcomes included favourable Glasgow Outcome Scale (GOS) scores, mortality, complications and postoperative ICP. Data were pooled using random-effects models and sensitivity analyses evaluated robustness. Results: Twelve studies (663 patients) were included. HC and DC demonstrated no significant difference in favourable GOS at discharge (Risk Ratio (RR) 1.51, 95% Confidence Interval (CI): 0.34–6.71) or six months (RR 1.23, 95% CI: 0.85–1.76). Mortality was comparable in-hospital (RR 1.20, 95% CI: 0.75–1.93) and at final follow-up (RR 0.80, 95% CI: 0.19–3.31). Postoperative ICP could not be reliably assessed due to limited and overlapping data. HC was associated with significantly lower hydrocephalus risk (RR 0.48, 95% CI: 0.36–0.65) and a non-significant effect suggesting fewer seizures (RR 0.64, 95% CI: 0.40–1.04). Conclusion: HC offers comparable mortality and functional outcomes to DC, with evidence of reduced hydrocephalus risk and a possible benefit in seizure incidence. Reliable assessment of postoperative ICP was not feasible, highlighting the need for more high-quality comparative trials.

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