Related Experiment Video
Updated: Jul 19, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
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.
Insights
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.
Abstract:
Traumatic brain injury is one of the leading causes of mortality and morbidity in children worldwide. In severe cases, high intracranial pressure is the most frequent cause of death. When first-line medical management fails, the neurosurgical procedure of decompressive craniectomy (DC) has been proposed for controlling intracranial pressure and improving the long-term outcomes for children with severe traumatic brain injury. However, the use of this procedure is controversial. The evidence from clinical trials shows some promise for the use of DC as an effective second-line treatment. However, it is limited by conflicting trial results, a lack of trials, and a high risk of bias. Furthermore, most research comes from retrospective observational studies and case series. This narrative review considers the strength of evidence for the use of DC in both a high income country and low-and-middle income country setting and examine how we can improve study design to better assess the efficacy of this procedure and increase the clinical translatability of results to centers worldwide. Specifically, we argue for a need for further studies with higher pediatric participant numbers, multicenter collaboration, and the use of a more consistent methodology to enable comparability of results among settings.
Related Concept Videos
01:28Traumatic Brain Injury l: Introduction
01:14Increased Intracranial Pressure l: Introduction