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Updated: Jul 19, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
[Decompressive craniectomy in children and adolescents with head injury: analysis of seven cases]
Rodrigo Moreira Faleiro1, Luiz Carlos Mendes Faleiro, Marcelo Magaldi Oliveira
1Hospital Pronto Socorro João XXIII, Rua Timbiras 3642/801, 30140-062 Belo Horizonte MG, Brazil. rfaleiro@brfree.com.br
Insights
Decompressive craniectomy (DC) is a feasible treatment for elevated intracranial pressure (ICP) in pediatric head injury patients, though complications can occur. Further multicentric studies are needed to establish optimal treatment protocols.
Area of Science:
- Neurosurgery
- Pediatric Critical Care
- Trauma Surgery
Context:
- Elevated intracranial pressure (ICP) following head injury presents a significant management challenge in pediatric patients.
- Decompressive craniectomy (DC) is a neurosurgical intervention employed to mitigate dangerously high ICP.
- The efficacy and safety of DC in the pediatric population remain subjects of ongoing debate and investigation.
Purpose:
- This study reports on seven pediatric cases managed with unilateral decompressive craniectomy (DC) for refractory intracranial pressure (ICP) secondary to head trauma.
- The objective was to evaluate the outcomes and complications associated with DC in this specific patient group.
Summary:
- Seven pediatric patients (ages 2-17) underwent unilateral DC for traumatic ICP. Outcomes varied, with mortality in three, severe disability in one, partial recovery in two, and full recovery in one at discharge.
- Long-term follow-up revealed significant functional improvement in previously disabled patients, with two achieving full recovery by six months.
- Complications included subdural collections, hydrocephalus, and superficial infection. Cranioplasty was performed in four patients.
Impact:
- Decompressive craniectomy (DC) demonstrates feasibility in reducing intracranial pressure (ICP) in pediatric head injury cases.
- Despite its potential benefits, DC is associated with a notable risk of complications, necessitating careful patient selection and monitoring.
- The findings underscore the need for larger, multicenter trials to develop standardized treatment protocols for decompressive craniectomy in pediatric neurotrauma.
Introduction:
Decompressive craniectomy (DC) is a surgical technique used to treat patients with elevated intracranial pressure often found in head injury. Its indication remains a controversial issue in the pediatric population.
Objective:
To report seven cases managed with this technique.
Method:
Retrospective study of seven patients, aged from 2 to 17 years, treated with unilateral DC due to increased intracranial pressure (ICP) as a consequence of head injury. All patients had ICP monitored post operatively and the DC classified as ultra-early (<6h), early (6-12h) or late (>24h) according to the time of its application. The minimum follow-up was six months.
Results:
Patients were evaluated with CT scans and clinical exams, and graded according the Glasgow Outcome Scale (GOS). Three patients deceased (GOS1), one was in vegetative state (GOS2), two recovered but still requiring nursing care (GOS3 and 4), and one had a full recovery (GOS5) at hospital discharge. After six months the GOS2 and a GOS3 patients achieved full recovery (GOS5). Subdural collection (2), hydrocephalus (1) and superficial infection (1) occurred as complication. Two patients had autologous cranioplasty and the other two heterologous cranioplasty.
Conclusion:
Decompressive craniectomy remains a feasible treatment method to lower the ICP, but is not safe from complications. A multicentric study should be done for appropriate protocol treatment of pediatric patients.
