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Updated: Apr 6, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy
Maroun J Mhanna1, Wael Ei Mallah1, Margaret Verrees2
1Departments of 1 Pediatrics.
Insights
Decompressive craniectomy (DC) in children with severe traumatic brain injury (TBI) may improve outcomes for survivors. This study found improved functional recovery in pediatric TBI patients who underwent early DC.
Area of Science:
- Neurosurgery
- Pediatric Critical Care
- Trauma Surgery
Background:
- Decompressive craniectomy (DC) is a debated procedure for severe traumatic brain injury (TBI).
- The efficacy of DC in improving outcomes for pediatric TBI patients remains unclear.
Purpose of the Study:
- To investigate whether DC enhances outcomes in children suffering from severe TBI.
- To compare outcomes between pediatric TBI patients treated with DC and those managed non-surgically.
Main Methods:
- A retrospective case-control study matched 17 pediatric TBI patients treated with DC to 17 controls treated medically.
- Data collected included demographics, Glasgow Coma Scale scores, intracranial pressure, and CT findings.
- Patient outcomes were assessed based on survival and functional recovery (Glasgow Outcome Scale).
Main Results:
- No significant differences in survival rates were observed between the DC group (71%) and the control group (82%).
- Patients undergoing DC showed a higher incidence of cerebral edema and herniation on CT scans.
- Among survivors, 42% of DC patients achieved mild disability (Glasgow Outcome Scale score 5) compared to none of the controls.
Conclusions:
- Early decompressive craniectomy in pediatric severe TBI patients may lead to improved functional outcomes in survivors.
- Further validation through prospective randomized controlled trials is necessary to confirm these findings.
- The study suggests a potential benefit of DC for functional recovery in pediatric TBI survivors.
Abstract:
OBJECT Decompressive craniectomy (DC) for the management of severe traumatic brain injury (TBI) is controversial. The authors sought to determine if DC improves the outcome of children with severe TBI. METHODS In a retrospective, case-control study, medical records of all patients admitted to the pediatric ICU between May 1998 and May 2008 with severe TBI and treated with DC were identified and matched to patients who were treated medically without DC. Medical records were reviewed for patients' demographic data and baseline characteristics. RESULTS During the study period, 17 patients with severe TBI treated with DC at a median of 2 hours (interquartile range [IQR] 1-14 hours) after admission were identified and matched to 17 contemporary controls. On admission, there were no differences between DC and control patients regarding age (10.2 ± 5.9 years vs 12.4 ± 5.4 years, respectively [mean ± SD]), sex, weight, Glasgow Coma Scale score (median 5 [IQR 3-7] vs 4 [IQR 3-6], respectively; p = 0.14), or the highest intracranial pressure (median 42 [IQR 22-54] vs 30 [IQR 21-36], respectively; p = 0.77). However, CT findings were significant for a higher rate of herniation and cerebral edema among patients with DC versus controls (7/17 vs 2/17, respectively, had herniation [p = 0.05] and 14/17 vs 6/17, respectively, had cerebral edema [p = 0.006]). Overall there were no significant differences in survival between patients with DC and controls (71% [12/17] vs 82% [14/17], respectively; p = 0.34). However, among survivors, at 4 years (IQR 1-6 years) after the TBI, 42% (5/12) of the DC patients had mild disability or a Glasgow Outcome Scale score of 5 vs none (0/14) of the controls (p = 0.012). CONCLUSIONS In this retrospective, small case-control study, the authors have shown that early DC in pediatric patients with severe TBI improves outcome in survivors. Future prospective randomized controlled studies are needed to confirm these findings.
