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Hinge craniotomy has been described as a feasible option for certain patients in need of decompression as a result of a mass lesion. The technique of hinging the bone flap alleviates the need to return to the operating room for cranioplasty as is the case with a traditional decompressive craniectomy. Intracranial pressure and brain tissue oxygenation monitoring can be utilized for intraoperative guidance to assess adequacy of hinge craniotomy. We report a case where intraoperative monitoring helped guide surgical decision making for a 23 year old male patient with a left traumatic subdural hematoma. The patient had a Licox monitor placed in the right frontal region, showing elevated intracranial pressure and decreased brain tissue oxygenation. The patient underwent hinge craniotomy, which initially lowered his intracranial pressure from 54 to 11 cm H2O and allowed his brain tissue oxygenation to rise to a normal value of 20.5 mm Hg. However, upon closure of the skin, the patient's intracranial pressure increased to 24 cm H2O and brain tissue oxygenation decreased to 7.8 mm Hg. As a result, the patient underwent decompressive craniectomy and the intracranial pressure and brain tissue oxygenation values normalized postoperatively. Intracranial pressure and brain tissue oxygenation can be helpful intraoperative guides in determining whether hinge craniotomy is adequate

Utilizing real-time pressure and tissue oxygenation monitoring to assess the adequacy of hinge craniotomy