Comparison of Outcomes of Hinge Craniotomy Versus Decompressive Craniectomy in Patients With Malignant Intracranial Hypertension: A Prospective, Randomized Controlled Study

Objective: This randomized controlled trial (RCT) aimed to compare the short-, mid-, and long-term outcomes in patients with malignant intracranial hypertension undergoing either decompressive craniectomy (DC) or hinge craniotomy (HC).

Methods: In this prospective RCT, 38 patients diagnosed with malignant intracranial hypertension due to ischemic infarction, traumatic brain injury, or non-lesional spontaneous intracerebral hemorrhage, who required cranial decompression, were randomly allocated to the DC and HC groups.

Results: The need for reoperation, particularly cranioplasty, in the DC group was significantly different from that in the HC group. The percentage of brain expansion was higher in the DC group versus the HC group; however, the difference was not significant. There was no significant intergroup difference in the functional outcome according to the modified Rankin Scale or the Glasgow Outcome Scale. Additionally, no significant intergroup differences were observed in the rates of in-hospital complications.

Conclusion: The HC and DC groups did not significantly differ in the rate of hospital complications such as infection, need for reoperation owing to the lack of intracranial pressure control, wound healing problems, or bone infection. Our results suggest that by performing HC, the probability of the need for major surgery (cranioplasty) is reduced, thereby removing financial burden from the patient and the health system.

Trial registration: Iranian Registry of Clinical Trials Identifier: IRCT20180515039678N1.