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Clinical Study of Decompressive Craniectomy in Children
Burcu Goker1, D Gucluhan Guclu, Ilyas Dolas
1Istinye University School of Medicine, Liv Hospital-Ulus, Department of Neurosurgery, Istanbul, Turkey.
Insights
Decompressive craniectomy (DC) can be effective for children with elevated intracranial pressure (ICP) from trauma or stroke. Further research is needed to optimize techniques and outcomes in pediatric patients.
Area of Science:
- Pediatric Neurosurgery
- Neurological Surgery
- Trauma Care
Background:
- Elevated intracranial pressure (ICP) is a critical condition in children, often resulting from head trauma or ischemic insults.
- Decompressive craniectomy (DC) is an established treatment for refractory ICP in adults, but its application in pediatric populations requires further investigation.
Purpose of the Study:
- To evaluate the clinical characteristics and outcomes of pediatric patients who underwent decompressive craniectomy (DC) for elevated intracranial pressure (ICP).
- To assess the safety and efficacy of DC in children experiencing severe neurological insults.
Main Methods:
- A retrospective study included twelve pediatric patients (≤17 years) who underwent DC between 2013 and 2018.
- Data collected included clinical status, radiological findings, surgical details (type, timing), and patient outcomes.
- Glasgow Coma Scale (GCS) scores and presenting pathologies were documented.
Main Results:
- The study included nine males and three females with a mean age of 10 years and an initial average GCS score of 6.
- All patients exhibited diffuse cerebral edema and subdural hematomas, with varied intracranial pathologies.
- Postoperative mortality was observed in three patients, and three others experienced severe disability.
Conclusions:
- Decompressive craniectomy (DC) shows potential efficacy in pediatric patients with elevated intracranial pressure (ICP), mirroring its success in adults.
- Significant brain differences in children necessitate large, well-designed clinical trials to refine DC techniques, timing, and to mitigate complications.
- Further research is crucial to establish optimal protocols for DC in pediatric neurosurgery.
Aim:
To evaluate the clinical characteristics of children who recently underwent decompressive craniectomy (DC) due to elevated intracranial pressure (ICP) correlated to head trauma or other causes, such as ischemic insult.
Material And Methods:
Twelve patients aged ≤17 years who underwent DC due to elevated ICP between 2013 and 2018 were included in the study. The clinical status of the participants, radiological characteristics, type and timing of surgery, and outcomes were recorded.
Results:
Three female and nine male patients with a mean age of 10 years were included. The initial average Glasgow Coma Scale score was 6 (3-12). All patients presented with signs of diffuse cerebral edema and subdural hematoma of various sizes along with other intracranial pathologies. Only one patient required bilateral frontal craniectomy. In the postoperative period, three patients died, and three had severe disability.
Conclusion:
With the increasing use and success of DC in adults, this procedure can also be effective in children. Considering brain differences in children, large and well-structured clinical trials must be conducted to prevent complications and to identify the best technique, timing, and benefits of DC for children.
