Decompressive craniectomy in paediatric traumatic brain injury: a systematic review of current evidence

Area of Science:

• Pediatric Neurosurgery
• Trauma Surgery
• Neurocritical Care

Background:

• Pediatric traumatic brain injury (pTBI) is a common cause of neurological disability in children.
• Effective management of elevated intracranial pressure (ICP) is critical for improving outcomes in pTBI.
• Decompressive craniectomy (DC) is a surgical intervention considered for refractory ICP in severe TBI.

Purpose of the Study:

• To systematically review the existing literature on the efficacy of decompressive craniectomy (DC) in pediatric traumatic brain injury (pTBI).
• To evaluate the impact of DC on intracranial pressure (ICP) control and long-term patient outcomes in pediatric populations.

Main Methods:

• A comprehensive literature search was conducted across MEDLINE and EMBASE databases.
• 12 studies met the inclusion criteria after screening 212 identified articles.
• Data extraction focused on patient demographics, injury severity (Glasgow Coma Scale), treatment, and short- and long-term outcomes.

Main Results:

• DC successfully controlled ICP in all nine studies that reported ICP as an outcome.
• Nine out of 11 studies showed positive or superior 6-12 month outcomes for patients treated with DC compared to medical management.
• Mortality was lower in the DC group in the two studies that compared mortality rates.

Conclusions:

• Current evidence suggests that decompressive craniectomy (DC) plays a beneficial role in managing intracranial pressure (ICP) in pediatric traumatic brain injury (pTBI).
• DC may lead to improved long-term functional outcomes for children suffering from severe pTBI.
• Further research is needed due to the limited number of studies investigating outcomes in pediatric TBI patients undergoing DC.