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Updated: Jul 16, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Outcomes after decompressive craniectomy for severe traumatic brain injury in children
Peter Kan1, Aminullah Amini, Kristine Hansen
1Department of Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84113-1100, USA.
Insights
Decompressive craniectomy can reduce intracranial pressure in severe traumatic brain injury (TBI). However, outcomes vary, with high mortality when performed for elevated ICP alone.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Critical Care Medicine
Background:
- Severe traumatic brain injury (TBI) in children can lead to fatal transtentorial herniation.
- Decompressive craniectomy (DC) is a surgical intervention to reduce elevated intracranial pressure (ICP).
- The efficacy and outcomes of DC in pediatric severe TBI require further evaluation.
Purpose of the Study:
- To evaluate mortality, morbidity, and long-term outcomes in children undergoing DC for severe TBI.
- To assess the impact of DC performed alone versus with mass lesion evacuation.
- To identify common complications following DC in pediatric TBI patients.
Main Methods:
- Retrospective review of 51 children with severe TBI who underwent DC between 1996-2005.
- Analysis of preoperative and postoperative Glasgow Coma Scale (GCS) scores and ICP levels.
- Long-term outcomes assessed using the King's Outcome Scale for Closed Head Injury (KOSCHI).
Main Results:
- Overall mortality was 31.4%.
- Children undergoing DC for elevated ICP alone had an exceedingly high mortality rate (5 out of 6).
- Common complications in survivors included hydrocephalus (40%) and epilepsy (20%).
Conclusions:
- Decompressive craniectomy is associated with significant mortality in pediatric severe TBI.
- Posttraumatic hydrocephalus and epilepsy are frequent complications after DC.
- Performing DC solely for elevated ICP in pediatric TBI carries a very high risk of death.
Object:
Severe traumatic brain injury (TBI) is often accompanied by early death due to transtentorial herniation. Decompressive craniectomy, performed alone or in conjunction with evacuation of the mass lesion, can reduce the incidence of raised intracranial pressure (ICP). In this paper the authors evaluate mortality and morbidity and long-term outcomes in children who underwent decompressive craniectomy for severe TBI at a single institution.
Methods:
Children with severe TBI who underwent decompressive craniectomy at the Primary Children's Medical Center between 1996 and 2005 were identified retrospectively. Descriptive statistics were used to report postoperative mortality and morbidity rates. Long-term recovery in patients who survived was reported using the King's Outcome Scale for Closed Head Injury (KOSCHI). Fifty-one children with a mean follow-up period of 18.6 months were identified. Nonaccidental trauma accounted for 23.5% of cases. The mean preoperative Glasgow Coma Scale (GCS) score was 4.6. Six patients underwent decompressive craniectomy for elevated ICP only; all other patients underwent decompressive craniectomy in conjunction with removal of the mass lesion. The mean postoperative GCS score was 9.7, and 69.4% of patients had normal ICP levels immediately after surgery. Sixteen children (31.4%) died, including five of six children who underwent decompressive craniectomy for raised ICP alone. Among surviving patients, 2.9% required a tracheostomy, 11.4% required a gastrostomy, 40% experienced posttraumatic shunt-dependent hydrocephalus, and 20% suffered posttraumatic epilepsy requiring antiepileptic agents. The mean KOSCHI score at the last follow-up examination was 4.5 and the mean time to cranioplasty was 2.3 months.
Conclusions:
Posttraumatic hydrocephalus and epilepsy were common complications encountered by children with severe TBI who underwent decompressive craniectomy. In patients who underwent decompressive surgery for raised ICP only, the mortality rate was exceedingly high.
