Hinged craniotomy (HC) is an alternative surgical technique that can be used in place of decompressive craniectomy (DC) to treat refractory intracranial hypertension. This procedure has the advantage of avoiding the need for a second surgery to replace the bone, while giving a good control of intracranial pressure. However, there is no consistent literature about complications of HC. In particular, there are no reported cases of contralateral subdural effusion (CSE) after HC. In this article we present a case of a 55-years-old man who developed CSE after a hinged craniotomy (HC) for intracranial hypertension, and how we handled it. Therefore, we explored literature to better understand the pathogenesis of CSE, treatments and possible prevention strategies.