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Decompressive craniectomy in children: indications and outcome from a tertiary centre
Subhas K Konar1, Y S Dinesh2, Dhaval Shukla2
1Department of Neurosurgery, National Institute of Mental Health, and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka, India. drsubhaskonar@gmail.com.
Insights
Decompressive craniectomy (DC) is a life-saving rescue therapy for intracranial hypertension in children. While outcomes are better in trauma cases, mortality remains high, especially in non-trauma patients.
Area of Science:
- Neurosurgery
- Pediatric Critical Care
- Trauma Surgery
Background:
- Decompressive craniectomy (DC) serves as a critical rescue therapy for managing intracranial hypertension.
- Indications for DC can be diverse, necessitating a clear understanding of patient profiles.
Purpose of the Study:
- To analyze the outcomes of decompressive craniectomy in pediatric patients.
- To identify factors influencing outcomes in trauma and non-trauma pediatric cases undergoing DC.
Main Methods:
- Retrospective review of clinical data, imaging, and operative findings for pediatric patients (≤18 years) who underwent DC over five years.
- Analysis of follow-up data to assess outcomes and identify predictive factors for unfavorable results.
Main Results:
- 128 pediatric patients underwent DC; 66 trauma and 62 non-trauma cases.
- Common indications included subdural hematoma and contusion (trauma), and infarction and venous thrombosis (non-trauma).
- Unfavorable outcomes were associated with lower Glasgow Coma Scale (GCS) scores and motor scores, particularly in non-trauma cases; GCS < 8 was a key predictor in trauma cases.
Conclusions:
- Decompressive craniectomy is a vital, life-saving procedure in pediatric neurosurgery.
- While unfavorable outcomes are slightly more common in non-trauma cases, mortality rates are notably high in trauma patients.
Introduction:
The role of decompressive craniectomy (DC) is as a rescue therapy for the treatment of intracranial hypertension. The indications for the DC are variable.
Methods:
The clinical details, imaging, operative findings and follow-up data of children less than or equal to 18 years of age were reviewed for more information on the children who underwent DC in the last 5 years.
Results:
During the study period, a total of 128 children underwent DC. The trauma cases were 66, and the non-trauma cases were 62. The common indication for DC was pure acute subdural hematoma 33 (50%), followed by contusion 10 (15%) in the trauma group, and in non-trauma, arterial infarction in 20 (32%) and cerebral venous thrombosis in 17 (27%). Hemicraniectomy was done in 114 (89%), and bifrontal craniectomy was done in 7 (5.4%) cases. The median duration follow-up was 7 months in non-trauma and 6 months in trauma. GCS was less than 8, the motor score was less than 3, and pupillary asymmetry, hypotension and basal cistern effacement were factors related to an unfavourable outcome in the non-trauma group. In regression analysis, only a motor score of less than three was associated with the non-trauma group. Age less than 10 years, GCS less than 8, motor score less than three and preoperative infarction were the predictive factors in univariate analysis, and only GCS less than 8 was the predictive factor for unfavourable factors in regression analysis in the trauma group.
Conclusion:
The DC is performed as a lifesaving procedure. The unfavourable outcome is slightly higher in non-trauma cases compared to trauma cases. However, the mortality rate is high in trauma cases.
