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Decompressive Craniectomy for Traumatic Intracranial Hypertension in Children

Zhanna B Semenova1, Semen Meshcheryakov2, Valery Lukyanov2

  • 1Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russia. JSeman@mail.ru.

Acta Neurochirurgica. Supplement
|April 11, 2021
PubMed

Insights

Decompressive craniectomy (DC) can improve outcomes in severe traumatic brain injury (TBI) by controlling intracranial pressure (ICP). However, factors like low Glasgow Coma Scale scores and pupil response predict unfavorable results in pediatric TBI patients.

Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Trauma Surgery

Background:

  • Decompressive craniectomy (DC) is a controversial procedure for managing refractory intracranial pressure (ICP) elevations.
  • Its invasiveness, undefined indications, variable outcomes, and complication risks contribute to ongoing debate.

Purpose of the Study:

  • To identify factors associated with unfavorable outcomes following DC in children with severe traumatic brain injury (TBI).

Main Methods:

  • A longitudinal study involving 64 children with severe TBI (mean age 4.8 years, GCS 6±2 on admission).
  • Follow-up was conducted over a 6-month period to assess outcomes.

Main Results:

  • Good recovery (GOS 4-5) occurred in 45.3%, severe disability (GOS 3) in 31.0%, and poor outcomes (GOS 1-2) in 23.4%.
  • Mortality rate was 18.7%.
  • Unfavorable prognostic signs included GCS < 5, dilated unreactive pupils, and ICP >40 mmHg. ICP characteristics were the most sensitive predictor.

Conclusions:

  • DC may prevent dislocation syndrome but can be futile in cerebral herniation.
  • Outcomes are primarily determined by the severity of primary and secondary brain injuries.
Abstract

Keywords:
ChildrenDecompressive craniectomyIntracranial pressureOutcomeSevere traumatic brain injury

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