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Background <p>Decompressive craniectomy is considered the standard surgical procedure for refractory intracranial hypertension in pediatric trauma brain injury. However, postoperative morbidity, complications, and the need for secondary cranioplasty are high. Hinge craniotomy has emerged as an alternative that preserves the bone flap and allows controlled decompression while reducing complications and surgical burden. Despite these results in the adult population and the variability of techniques, evidence in pediatric patients remains limited.</p> Objective <p>To summarize the available literature on hinge craniotomy in pediatric TBI and to describe the current practice and attitudes of Mexican neurosurgeons regarding decompressive techniques in this population.</p> Methods <p>A narrative literature review was conducted to identify reports describing the use of hinge or floating craniotomy in pediatric TBI. Additionally, a national survey was distributed among Mexican surgeons to assess the clinical practice, experience, and resource availability in pediatric patients with severe TBI.</p> Results <p>Only eight studies specifically addressing pediatric hinge craniotomy were identified, most being small case series with variable techniques and follow-up durations. Overall, these studies suggest that HC achieves adequate intracranial decompression with fewer complications related to cranioplasty. In the national survey (<i>n</i> = 68), 84% of respondents were neurosurgeons and 16% pediatric neurosurgeons. Most participants reported limited access to intracranial pressure monitoring (80%), and 30% indicated using hinge or floating craniotomy as their first-line decompressive procedure in pediatric TBI. A majority (58%) believed that the advantages of HC diminish with age, though the threshold age varied widely among respondents.</p> Conclusions <p>Hinge craniotomy appears to be a safe and practical alternative to decompressive craniectomy in pediatric TBI, offering potential advantages in reducing complications and avoiding secondary cranioplasty. Nevertheless, the available evidence is scarce and heterogeneous, underscoring the need for standardized protocols and multicenter pediatric studies.</p>

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Hinge craniotomy in pediatric traumatic brain injury: a narrative review and national survey among Mexican neurosurgeons

  • 期刊论文

  • 发表日期：

    2026年4月10日

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  • José A. Franco-Jiménez,
  • Alejandro Ceja-Espinosa,
  • Horus Martínez-Maldonado,
  • Antonio Sosa-Nájera

摘要

Background

Decompressive craniectomy is considered the standard surgical procedure for refractory intracranial hypertension in pediatric trauma brain injury. However, postoperative morbidity, complications, and the need for secondary cranioplasty are high. Hinge craniotomy has emerged as an alternative that preserves the bone flap and allows controlled decompression while reducing complications and surgical burden. Despite these results in the adult population and the variability of techniques, evidence in pediatric patients remains limited.

Objective

To summarize the available literature on hinge craniotomy in pediatric TBI and to describe the current practice and attitudes of Mexican neurosurgeons regarding decompressive techniques in this population.

Methods

A narrative literature review was conducted to identify reports describing the use of hinge or floating craniotomy in pediatric TBI. Additionally, a national survey was distributed among Mexican surgeons to assess the clinical practice, experience, and resource availability in pediatric patients with severe TBI.

Results

Only eight studies specifically addressing pediatric hinge craniotomy were identified, most being small case series with variable techniques and follow-up durations. Overall, these studies suggest that HC achieves adequate intracranial decompression with fewer complications related to cranioplasty. In the national survey (n = 68), 84% of respondents were neurosurgeons and 16% pediatric neurosurgeons. Most participants reported limited access to intracranial pressure monitoring (80%), and 30% indicated using hinge or floating craniotomy as their first-line decompressive procedure in pediatric TBI. A majority (58%) believed that the advantages of HC diminish with age, though the threshold age varied widely among respondents.

Conclusions

Hinge craniotomy appears to be a safe and practical alternative to decompressive craniectomy in pediatric TBI, offering potential advantages in reducing complications and avoiding secondary cranioplasty. Nevertheless, the available evidence is scarce and heterogeneous, underscoring the need for standardized protocols and multicenter pediatric studies.