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Published on: February 15, 2008
Bilateral decompressive craniectomy in pediatric patients: A systematic review
Yaxel Levin-Carrion1, Kevin Titkov2, Isabella Chamma2
1Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA. YL1177@njms.rutgers.edu.
Neurosurgical Review
|May 30, 2026
Summary
Decompressive craniectomy (DC) is a salvage option for pediatric intracranial hypertension. However, evidence for specific bilateral DC techniques in children is limited and heterogeneous, requiring further research.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Critical Care Medicine
Background:
- Traumatic brain injury (TBI) and acute neurological insults are major causes of pediatric morbidity and mortality.
- Elevated intracranial pressure (ICP) refractory to medical management may necessitate decompressive craniectomy (DC).
- The role and outcomes of specific bilateral DC approaches (bifrontal, bitemporal, cruciate) in pediatric populations are poorly defined.
Purpose of the Study:
- To review the current evidence on bilateral, bifrontal, bitemporal, and cruciate decompressive craniectomy in pediatric and young adult patients.
- To synthesize data on the feasibility, timing, complications, and outcomes of these salvage interventions.
- To identify gaps in knowledge and guide future research directions.
Main Methods:
- A systematic literature search was conducted following PRISMA guidelines across PubMed, Scopus, Embase, and PubMed Central.
- English-language studies reporting specific bilateral DC techniques in patients aged ≤21 years with refractory intracranial hypertension were included.
- Data extraction and qualitative synthesis were performed due to clinical and methodological heterogeneity.
Main Results:
- Five studies met eligibility criteria, including one pilot RCT and four observational cohorts, primarily focusing on severe TBI.
- Evidence was heterogeneous regarding indications, ICP thresholds, surgical timing, techniques, and outcome measures.
- Reported outcomes including mortality, functional recovery, and complications varied, with limited data suggesting early decompression may be beneficial.
Conclusions:
- Bilateral, bifrontal, bitemporal, and cruciate DC are feasible salvage strategies for selected pediatric patients with refractory intracranial hypertension.
- Current evidence is sparse, heterogeneous, and lacks technique-specific detail, precluding definitive conclusions on efficacy or optimal timing.
- Prospective multicenter studies with standardized protocols are essential to advance understanding and guide clinical practice.
