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Greenstick fracture-hinge decompressive craniotomy in infants: illustrative case and literature review of techniques for decompressive craniotomy without bone removal

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Abstract

Purpose

We present the potential usefulness of a greenstick fracture-hinge decompressive craniotomy, a variant of a hinge-craniotomy, as an alternative technique for use with a decompressive craniectomy (DC) in infants. A literature review of hinge-craniotomy procedures and technical variants is also provided, with a focus on complications associated with a DC peculiar to infants and children.

Methods

Illustrative case presentation along with literature review.

Result

Significant rates of complications associated with a DC and subsequent cranioplasty have been reported, such as bone flap resorption, hydrocephalus, cerebrospinal fluid collection, and infection, especially in infants. A hinge-craniotomy is an older technique reported to have potential usefulness with some modifications, though concerns have been raised about adequate decompression and definitive indications.

Conclusion

A DC procedure performed in children, especially infants, includes a significantly high risk of various complications; thus, a hinge-craniotomy technique is worthwhile for consideration to avoid such complications. Additional studies are required to clarify whether this technique may contribute to reduce complications related to a DC in infants and children.

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Fig. 1
Fig. 2

Abbreviations

ASDH:

Acute subdural hematoma

CT:

Computed tomography

CSF:

Cerebrospinal fluid

DC:

Decompressive craniectomy

ICP:

Intracranial pressure

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Authors and Affiliations

  1. Department of Neurosurgery, Osaka General Medical Center, 3-1-56 Bandai-higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan

    Hiroshi Yokota, Tadashi Sugimoto, Mitsuhisa Nishiguchi & Hiroyuki Hashimoto

Authors
  1. Hiroshi Yokota
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  2. Tadashi Sugimoto
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  3. Mitsuhisa Nishiguchi
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  4. Hiroyuki Hashimoto
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Correspondence to Hiroshi Yokota.

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Yokota, H., Sugimoto, T., Nishiguchi, M. et al. Greenstick fracture-hinge decompressive craniotomy in infants: illustrative case and literature review of techniques for decompressive craniotomy without bone removal. Childs Nerv Syst 35, 1491–1497 (2019). https://doi.org/10.1007/s00381-019-04177-1

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