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Decompressive Craniectomy for Pediatric Traumatic Brain Injury in Low-and-Middle Income and High Income Countries
Ryan Gidda1, Soham Bandyopadhyay1, Noel Peter1
1Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.
World Neurosurgery
|July 25, 2022
Summary
Decompressive craniectomy (DC) may help children with severe traumatic brain injury by reducing intracranial pressure. However, more high-quality, multicenter studies are needed to confirm its effectiveness and improve global treatment consistency.
Area of Science:
- Pediatric Neurosurgery
- Neurocritical Care
- Trauma Surgery
Background:
- Traumatic brain injury (TBI) is a major cause of death and disability in children globally.
- Elevated intracranial pressure (ICP) is a primary driver of mortality in severe pediatric TBI.
- Decompressive craniectomy (DC) is a neurosurgical option for refractory ICP in severe TBI.
Purpose of the Study:
- To review the current evidence for decompressive craniectomy (DC) in pediatric severe traumatic brain injury (sTBI).
- To evaluate the efficacy of DC in high-income versus low- and middle-income country settings.
- To propose improvements in study design for future research on pediatric DC.
Main Methods:
- This is a narrative review of existing literature on decompressive craniectomy for pediatric severe traumatic brain injury.
- The review synthesizes evidence from clinical trials, retrospective observational studies, and case series.
- It critically examines the quality of evidence and discusses methodological limitations.
Main Results:
- Evidence for DC in pediatric sTBI is limited by conflicting results, few trials, and high risk of bias.
- Existing research predominantly consists of retrospective studies and case series.
- The effectiveness of DC may vary between high-income and low- and middle-income country contexts.
Conclusions:
- Decompressive craniectomy (DC) shows potential as a second-line treatment for pediatric severe traumatic brain injury (sTBI) but requires further investigation.
- Improved study designs, including larger pediatric cohorts, multicenter collaboration, and standardized methodologies, are crucial.
- Enhanced research will improve the clinical translatability of findings and optimize outcomes for children with sTBI worldwide.
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01:28Traumatic Brain Injury l: Introduction
DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...
01:14Increased Intracranial Pressure l: Introduction
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...