Clinical Outcomes of Hinged Craniotomy as an Alternative Surgery Technique Compared to Conventional Decompressive Craniectomy for Traumatic Brain Injury: A Systematic Review.

Hinge craniotomy (HC) is a relatively underused surgical technique for managing increased intracranial pressure in patients with traumatic brain injury (TBI). As an alternative to conventional decompressive craniectomy (DC), HC preserves the native bone flap and may obviate the need for subsequent cranioplasty. This systematic review summarizes and compares the clinical outcomes of HC and DC in adult patients with TBI. Electronic databases were systematically searched for studies evaluating these 2 techniques. Outcomes, including functional recovery, mortality, complications, and reoperation rates, were analyzed and albatross plots were used to synthesize the data. Across studies, HC demonstrated outcomes broadly comparable to those of DC, with some studies suggesting trends toward lower early mortality and fewer poor functional outcomes, although these findings were not statistically significant. Overall, both procedures showed similar safety and efficacy profiles, whereas HC offered the potential advantage of avoiding secondary cranioplasty. Larger, well-designed prospective studies are required to confirm these findings and to better define the appropriate patient selection criteria. Trial Registration: PROSPERO Identifier: CRD42025638233.