Pupillomotor Dysfunction and Outcomes After Decompressive Craniectomy in Pediatric Patients.

Area of Science:

• Pediatric Neurosurgery
• Critical Care Medicine
• Neurological Surgery

Background:

• Decompressive craniectomy (DC) is vital for refractory intracranial pressure (ICP).
• Pediatric outcomes post-DC, particularly pupillomotor dysfunction, are understudied.
• Anisocoria's significance in pediatric DC warrants further investigation.

Purpose of the Study:

• To evaluate the clinical relevance of pupillomotor dysfunction in pediatric patients undergoing DC.
• To assess the association between pupillomotor dysfunction and outcomes in pediatric DC.
• To explore long-term functional recovery in pediatric DC survivors.

Main Methods:

• Retrospective review of 25 pediatric patients undergoing DC (2004-2024).
• Data collected: demographics, etiology, surgical details, neurological status (GCS, pupillary status), and midline shift.
• Functional outcomes assessed using pediatric Glasgow Outcome Scale Extended (pGOS-E) over 4 years.

Main Results:

• Traumatic brain injury was the leading cause (16/25).
• Pupillomotor dysfunction occurred in 15/25 patients, associated with increased in-hospital mortality (p=0.02).
• Survivors with initial dysfunction showed moderate disability (median pGOS-E=6 at 12 months).

Conclusions:

• Pediatric pupillomotor dysfunction predicts higher early mortality but not necessarily poor long-term outcomes.
• Children demonstrate substantial neurological recovery potential post-DC, even with severe initial findings.
• Timely surgical intervention should be considered despite initial clinical severity.