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



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.

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Fig. 1
Fig. 2



Acute subdural hematoma


Computed tomography


Cerebrospinal fluid


Decompressive craniectomy


Intracranial pressure


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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).

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