Child's Nervous System

, Volume 35, Issue 9, pp 1491–1497 | Cite as

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

  • Hiroshi YokotaEmail author
  • Tadashi Sugimoto
  • Mitsuhisa Nishiguchi
  • Hiroyuki Hashimoto
Focus Session



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.


Illustrative case presentation along with literature review.


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.


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.


Abusive head trauma Acute subdural hematoma Children Decompressive craniotomy Decompressive craniectomy Hinge-craniotomy Infant 



Acute subdural hematoma


Computed tomography


Cerebrospinal fluid


Decompressive craniectomy


Intracranial pressure


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare in regard to this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hiroshi Yokota
    • 1
    Email author
  • Tadashi Sugimoto
    • 1
  • Mitsuhisa Nishiguchi
    • 1
  • Hiroyuki Hashimoto
    • 1
  1. 1.Department of NeurosurgeryOsaka General Medical CenterOsakaJapan

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