Temporalis-Based Hinge Craniotomy: Technical Modification of Decompressive Craniectomy in Head Injury

Background: Decompressive craniectomy (DC) was proven to be an effective therapy for intractable post traumatic elevation of intracranial pressure. Hinge craniotomy is a modification for DC, decreasing the potential associated morbidities and the need for a delayed Crainoplasty. Objective: The aim of the current study is to assess a modification for this procedure, using the patient’s own temporalis muscle as a hinge for the bone flap. Patients and Methods: This is a prospective study on 20 post traumatic cases indicated for decompressive craniectomy. In situ temporalis hinged decompressive craniotomy was done for all cases. Cases were followed up regarding their GCS, midline shift in CT scans, as well as ICP monitor values. Results: 85% of cases showed midline shift improvement in postoperative CT-scans, 75% of cases had postoperative GCS15. ICP monitoring was used in only 5 cases, all of which showed normalization of ICP within 48 hours. We had 3 mortalities (15%) in our study. Conclusion: Temporalis based hingingis a simple, less costly, and effective alternative for metallic plate application for in situ hinged craniotomy in cases of refractory post traumatic elevation of ICP related to head injury.