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Decompressive hemicraniectomy in a 2-year-old girl with a left middle cerebral artery infarct
Marilyn A Tan1, Aida M Salonga, Roland Dominic G Jamora
1Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Taft Avenue, Ermita, Manila, 1000, Philippines. marlmd@yahoo.com
Insights
Decompressive hemicraniectomy saved a young child with a brain clot after heart surgery. This life-saving procedure is crucial for severe brain swelling unresponsive to other treatments.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Cardiology
Background:
- Congenital heart disease (CHD) presents complex challenges, including potential cerebrovascular complications.
- Post-operative complications following cardiac surgery in pediatric patients require vigilant monitoring.
Observation:
- A 2-year, 5-month-old girl with CHD developed left middle cerebral artery occlusion and hemorrhagic infarction post-ventricular septal defect repair.
- Cranial CT confirmed acute hemorrhagic infarct in the left MCA territory, causing significant midline shift.
Findings:
- Medical management proved ineffective for the severe brain swelling and herniation.
- Decompressive hemicraniectomy with duraplasty was successfully performed, reversing herniation in this pediatric patient.
- This represents the youngest reported case of decompressive hemicraniectomy for MCA territory infarction.
Implications:
- Decompressive hemicraniectomy is a critical, potentially life-saving intervention for refractory intracranial hypertension.
- Early consideration of decompressive surgery may improve outcomes in pediatric stroke patients with severe brain swelling.
- While life-saving, functional outcomes following this procedure in pediatric stroke warrant further investigation.
Introduction:
We report on the case of a 2-year 5-month-old girl with congenital heart disease who developed left middle cerebral artery occlusion and cerebral hemorrhagic infarction a day after ventricular septal defect patch closure.
Results:
Cranial computed tomography scan revealed an acute hemorrhagic infarct over the left middle cerebral artery territory with midline shift to the right. Since medical treatment failed, decompressive hemicraniectomy with duraplasty was performed, successfully reversing herniation. Decompressive surgery allows extracranial expansion of the swollen brain and relieves CSF space compression. We believe this to be the youngest reported patient to undergo decompressive hemicraniectomy for middle cerebral artery territory infarction. Although the patient survived, her functional outcome was poor.
Conclusion:
Decompressive hemicraniectomy can be lifesaving and should be considered as an alternative therapy for patients with brain swelling refractory to medical management.
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