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Decompressive craniectomy in pediatric patients with traumatic brain injury: an up to date comprehensive review
Atef F Hulliel1, Omar H Abuhashem2, Rama S Tarabsheh3
1Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030, Irbid, 22110, Jordan. afhulliel181@med.just.edu.jo.
Insights
Decompressive craniectomy (DC) offers survival with meaningful recovery for nearly two-thirds of pediatric traumatic brain injury (TBI) patients. Further research is needed to optimize patient selection and surgical timing for better outcomes in TBI care.
Area of Science:
- Neurosurgery
- Pediatric Critical Care
- Trauma Surgery
Background:
- Traumatic brain injury (TBI) is a major cause of death and disability in children globally.
- Decompressive craniectomy (DC) is a life-saving procedure for refractory intracranial hypertension but its use in pediatric TBI is debated.
- Optimal timing and long-term results of DC in pediatric TBI require further investigation.
Purpose of the Study:
- To systematically review the current evidence on decompressive craniectomy (DC) for pediatric traumatic brain injury (TBI).
- To evaluate the efficacy, safety, and outcomes of DC in children with TBI.
- To identify factors influencing outcomes in pediatric TBI patients undergoing DC.
Main Methods:
- A systematic review was conducted following PRISMA guidelines, searching PubMed and Scopus.
- Included studies involved pediatric patients (<18 years) with TBI undergoing DC, reporting clinical outcomes.
- Data extraction focused on patient demographics, surgical details, and outcomes; quality was assessed using a modified Newcastle-Ottawa Scale; pooled analyses were performed.
Main Results:
- 33 studies with 666 pediatric patients were analyzed; most were observational.
- The pooled rate of favorable outcomes was 66.1%, with a pooled mortality of 18.9%.
- Higher initial Glasgow Coma Scale scores and larger study cohorts were associated with more favorable outcomes.
Conclusions:
- Decompressive craniectomy (DC) is a critical intervention for severe pediatric TBI, providing survival and meaningful recovery in a majority of cases.
- Significant heterogeneity in existing studies highlights the need for standardized reporting.
- Well-designed multicenter trials are essential to optimize patient selection and surgical timing for pediatric TBI management.
Introduction:
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality among children worldwide. Decompressive craniectomy (DC) is considered a life-saving option for refractory intracranial hypertension, yet its role, timing, and long-term outcomes in the pediatric population remain controversial.
Method:
We conducted a systematic review in accordance with PRISMA guidelines, searching PubMed and Scopus up to 2025. Eligible studies included pediatric patients (< 18 years) with TBI who underwent DC and reported outcomes. Data were extracted on patient characteristics, timing and type of surgery, and clinical outcomes. Methodological quality was assessed using a modified Newcastle-Ottawa Scale. Pooled analyses were performed for mortality and functional recovery.
Results:
A total of 33 studies, comprising 666 pediatric patients, were included. Most studies were observational, with one randomized controlled trial. The mean age ranged from 1.6 to 16 years, and initial Glasgow Coma Scale scores from 3 to 10. Hemidecompression was the most common surgical approach. The pooled favorable outcome rate was 66.1% (95% CI 55.4-76.0), while pooled mortality was 18.9% (95% CI 13.6-24.8). Favorable outcomes were more frequent in patients with higher initial GCS (> 6) and in larger cohorts.
Conclusion:
DC remains a critical intervention for severe pediatric TBI, offering survival with meaningful recovery in nearly two-thirds of cases. However, significant heterogeneity exists, underscoring the need for standardized reporting and well-designed multicenter trials to optimize patient selection and timing.
