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Decompressive craniectomy and CSF disorders in children
Marie Manfiotto1, Carmine Mottolese2, Alexandru Szathmari2
1Centre Hospitalier Universitaire de Nice, Nice, France.
Insights
Cerebrospinal fluid (CSF) disorders affect a small percentage of children after decompressive craniectomy (DC) for traumatic brain injury (TBI). Close monitoring is essential, as complications like cranioplasty infection risk increase with CSF shunting.
Area of Science:
- Pediatric Neurosurgery
- Traumatic Brain Injury Management
- Cerebrospinal Fluid Dynamics
Background:
- Decompressive craniectomy (DC) is a critical intervention for severe traumatic brain injury (TBI).
- Post-DC complications include impaired cerebrospinal fluid (CSF) dynamics.
- Understanding CSF alteration incidence and impact is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the incidence of CSF disorders after DC in pediatric TBI patients.
- To review the impact of these CSF alterations on patient outcomes.
- To identify risk factors associated with CSF disorders post-DC.
Main Methods:
- Retrospective multicentric study.
- Analysis of pediatric patients (0-17 years) undergoing DC for TBI.
- Data collected from major French Pediatric Neurosurgery Departments (2006-2016).
Main Results:
- 10.67% of 150 pediatric TBI patients developed CSF disorders post-DC.
- Sixteen patients required extrathecal CSF shunting.
- External ventricular drainage significantly increased cranioplasty infection risk (p=0.008).
Conclusions:
- CSF disorders are infrequent but significant complications following pediatric DC for TBI.
- Complications can manifest months post-cranioplasty, necessitating long-term follow-up.
- External ventricular drainage and CSF shunting elevate cranioplasty infection risk.
Introduction:
Decompressive craniectomy (DC) is a lifesaving procedure but is associated to several post-operative complications, namely cerebrospinal fluid (CSF) dynamics impairment. The aim of this multicentric study was to evaluate the incidence of such CSF alterations after DC and review their impact on the overall outcome.
Material And Methods:
We performed a retrospective multicentric study to analyze the CSF disorders occurring in children aged from 0 to 17 years who had undergone a DC for traumatic brain injury (TBI) in the major Departments of Pediatric Neurosurgery of France between January 2006 and August 2016.
Results:
Out of 150 children, ranging in age between 7 months and 17 years, mean 10.75 years, who underwent a DC for TBI in 10 French pediatric neurosurgical centers. Sixteen (6 males, 10 females) (10.67%) developed CSF disorders following the surgical procedure and required an extrathecal CSF shunting. External ventricular drainage increased the risk of further complications, especially cranioplasty infection (p = 0.008).
Conclusion:
CSF disorders affect a minority of children after DC for TBI. They may develop early after the DC but they may develop several months after the cranioplasty (8 months), consequently indicating the necessity of clinical and radiological close follow-up after discharge from the neurosurgical unit. External ventricular drainage and permanent CSF shunt placement increase significantly the risk of cranioplasty infection.
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