Bifrontal decompressive craniotomy in a 6-month-old infant with posttraumatic refractory intracranial hypertension
1Neurosurgery Division, KKUH, College of Medicine, King Saud University, Riyadh 11472, Saudi Arabia. smfwat@yahoo.com
Insights
Bifrontal decompressive craniotomy (BDC) can be life-saving for infants with severe brain swelling and infarction. This procedure effectively treated refractory intracranial hypertension (IH) in a young child after severe head trauma.
Area of Science:
- Neurosurgery
- Pediatric Critical Care
- Trauma Surgery
Background:
- Severe head injuries in infants can lead to catastrophic intracranial hypertension (IH).
- Refractory IH despite medical management poses a significant challenge in pediatric neurotrauma.
- Massive brain infarction complicates the prognosis in severe pediatric head injuries.
Observation:
- A 6-month-old infant sustained a severe closed head injury with rapid neurological decline.
- Clinical presentation included a Glasgow Coma Scale score of 6/15 and fixed dilated pupils.
- Cranial CT revealed extensive bilateral cerebral swelling and infarction, unresponsive to maximal medical therapy.
Findings:
- Bifrontal decompressive craniotomy (BDC) with duraplasty was performed 8 hours after admission.
- The infant demonstrated a rapid recovery, achieving a Glasgow Outcome Score of 3.
- The total hospital stay was 10 weeks, indicating a positive outcome post-intervention.
Implications:
- BDC is a viable and potentially life-saving surgical option for infants with refractory IH and extensive brain infarction.
- Early surgical intervention may improve outcomes in pediatric patients with severe traumatic brain injury.
- This case highlights the critical role of decompressive surgery in managing severe pediatric head trauma.
Objective:
To document the outcome of bifrontal decompressive craniotomy (BDC) in an infant who developed refractory intracranial hypertension (IH) and massive brain infarction following severe head injury.
Clinical Presentation:
A 6-month-old girl sustained a severe closed head injury in a car accident. Her Glasgow coma score dropped from 10 to 6/15 within 6 h after admission, and her pupils became dilated and fixed. CT brain scans showed severe brain swelling and extensive infarction in both cerebral hemispheres with no grey-white mater differentiation. She developed a state of refractory IH despite maximal medical treatment.
Intervention:
She had BDC and duraplasty carried out 8 h after admission. She made a quick recovery to Glasgow outcome score 3, and her total hospital stay was 10 weeks.
Conclusion:
BDC can be a life-saving procedure for infants with refractory IH and massive brain infarction.
