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Early versus Late Decompressive Craniectomy in Pediatrics with Traumatic Brain Injuries: A Retrospective Study.

Amer Jaradat1, Mohammed M Al Barbarawi1, Mohammad Jamous1

  • 1Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

World Neurosurgery
|February 26, 2025
PubMed
Summary

Decompressive craniectomy (DC) is vital for severe traumatic brain injury (TBI) in children to manage intracranial pressure. This study found no significant outcome difference between early and late DC, but pupillary abnormalities indicated prognosis.

Keywords:
Decompressive craniectomyPediatricsTraumatic brain injuries

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Area of Science:

  • Pediatric Neurosurgery
  • Trauma Surgery
  • Critical Care Medicine

Background:

  • Severe traumatic brain injury (TBI) is a major cause of death and disability in children globally.
  • Effective management of TBI involves controlling intracranial pressure (ICP).
  • Decompressive craniectomy (DC) is a critical intervention for refractory ICP in severe TBI.

Purpose of the Study:

  • To investigate the effectiveness of early decompressive craniectomy (DC) in pediatric severe TBI.
  • To evaluate the impact of surgical timing on patient outcomes.
  • To identify prognostic factors in pediatric severe TBI patients undergoing DC.

Main Methods:

  • Retrospective analysis of pediatric patients (<16 years) with severe TBI.
  • Inclusion criteria: patients undergoing DC within 24 hours of injury.
  • Data collected on patient demographics, outcomes, complications, and surgical timing.

Main Results:

  • A cohort of 45 pediatric patients with severe TBI undergoing DC was analyzed.
  • Favorable outcomes (Glasgow Outcome Score 4-5) were observed in 67% of cases.
  • Pupillary abnormalities were significantly linked to prognosis (P=0.004), while surgical timing was not (P=0.661).

Conclusions:

  • Decompressive craniectomy (DC) remains essential for managing pediatric severe TBI and ICP.
  • This study found no significant difference in outcomes between early and late DC.
  • Pupillary abnormalities are a critical prognostic indicator; further research on optimal surgical timing is warranted.