Decompressive craniectomy in children: single-center series and systematic review
Related Experiment Video
Updated: May 29, 2026
A Craniotomy Surgery Procedure for Chronic Brain Imaging
Published on: February 15, 2008
Erdem Güresir1, Patrick Schuss, Volker Seifert
1Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. Gueresir@em.uni-frankfurt.de
Insights
Decompressive craniectomy (DC) in children with brain swelling can be life-saving. This study found a 62% favorable outcome, suggesting DC may be warranted for traumatic or nontraumatic brain swelling in pediatric patients.
Area of Science:
- Neurosurgery
- Pediatric Critical Care
- Neurology
Background:
- Decompressive craniectomy (DC) is a critical intervention for elevated intracranial pressure in pediatric patients.
- The efficacy and indications for DC in children remain subjects of ongoing research and debate.
- This study investigates factors influencing outcomes in pediatric DC cases.
Purpose of the Study:
- To identify key factors affecting the outcomes of pediatric patients undergoing decompressive craniectomy.
- To evaluate the success rates of DC in children with various causes of increased intracranial pressure.
- To provide evidence-based insights for decision-making in pediatric neurosurgery.
Main Methods:
- A retrospective analysis of 34 pediatric patients (0-18 years) who underwent DC between 2000-2009.
- Stratification of patients based on the indication for DC (traumatic vs. non-traumatic brain injury).
- Literature review of 172 pediatric DC cases to augment sample size; outcome assessment using the modified Rankin Scale at 6 months.
Main Results:
- Overall, 62% (106/172) of pediatric patients achieved a favorable outcome post-DC.
- Patients without traumatic brain injury showed a slightly higher favorable outcome rate (69%) compared to those with TBI (60%).
- Absence of cerebral herniation signs correlated with better outcomes (73%) versus unilateral (60%) or bilateral dilated pupils (45%).
Conclusions:
- Decompressive craniectomy may be a viable treatment for pediatric brain swelling, irrespective of the cause (traumatic or non-traumatic).
- Favorable outcomes are achievable even in pediatric patients presenting with mydriasis (pupil dilation).
- Individualized patient assessment is crucial, particularly in cases with prolonged signs of cerebral herniation.
Background:
Decompressive craniectomy (DC) is performed as a life-saving procedure in patients with intractably increased intracranial pressure after traumatic brain injury, bleeding, cerebral infarction, or brain swelling of other causes. However, the application of DC is as controversial in the pediatric population as it is in adults.
Objective:
To find factors influencing the outcome in pediatric patients who underwent DC because of sustained high intracranial pressure.
Methods:
Between April 2000 and December 2009, 34 pediatric patients (age 0-18 years) underwent DC. Patients were stratified according to the indication for DC. Outcome was assessed according to the modified Rankin Scale score at 6 months. MEDLINE was searched for published studies or reports of DC in pediatric patients to gain a larger population. Two reviewers independently extracted data.
Results:
Literature data, including the current series, revealed a total of 172 pediatric patients. Overall, a favorable outcome was achieved in 106 of 172 patients (62%). A favorable outcome was achieved in 25 of 36 patients without traumatic brain injury vs 81 of 136 patients with traumatic brain injury (69% vs 60%). Patients without signs of cerebral herniation had a better outcome than patients with unilateral or bilateral dilated pupils (73% vs 60% vs 45%, respectively).
Conclusion:
The current data indicate that DC in children with traumatic or nontraumatic brain swelling might be warranted, regardless of the underlying cause. Despite mydriasis, a favorable outcome might be achieved in a significant number of pediatric patients. Nevertheless, careful individual decision making is needed for each patient, especially when signs of cerebral herniation have persisted for a long time.
