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Decompressive craniectomy after severe traumatic brain injury in children: complications and outcome

Astrid Pechmann1, Constantin Anastasopoulos1, Rudolf Korinthenberg1

  • 1Division of Neuropediatrics and Muscle Disorders, University Medical Center Freiburg, Freiburg, Germany.

Neuropediatrics
|October 25, 2014
PubMed

Insights

Decompressive craniectomy (DC) in children with severe traumatic brain injury (TBI) leads to frequent complications, including hygroma and bone resorption. These issues often necessitate additional surgeries, impacting patient recovery.

Area of Science:

  • Neurosurgery
  • Pediatric Critical Care
  • Trauma Surgery

Background:

  • Decompressive craniectomy (DC) is a neurosurgical procedure used to reduce intracranial pressure following severe traumatic brain injury (TBI).
  • While beneficial in pediatric populations, DC is often reserved as an emergency procedure due to potential complications.

Purpose of the Study:

  • To identify secondary complications and long-term sequelae of decompressive craniectomy in children with severe TBI.
  • To evaluate the impact of these complications on subsequent surgical interventions and patient outcomes.

Main Methods:

  • Retrospective review of pediatric patients who underwent DC for severe TBI at University Medical Center Freiburg (2005-2013).
  • Analysis of complication rates, need for further surgical procedures, and long-term outcomes using the Glasgow Outcome Scale.

Main Results:

  • Twelve pediatric patients with a mean Glasgow Coma Scale of 4.5 were included.
  • High complication rates observed: hygroma (83%), aseptic bone resorption (50%), hydrocephalus (42%), shunt/cranioplasty issues (25-33%), and epilepsy (33%).
  • Seventy-five percent of patients required additional surgeries beyond cranioplasty, with some undergoing up to eight interventions.

Conclusions:

  • Decompressive craniectomy in pediatric severe TBI is associated with a high incidence of secondary complications.
  • These complications frequently lead to further surgical procedures, prolonged hospitalization, and impact long-term outcomes.
  • The potential for significant complications must be carefully considered when deciding on DC as an emergency procedure in children.

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