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Early Postoperative Complications after Decompressive Craniectomy for Pediatric Severe Traumatic Brain Injury

Zhanna Semenova1, Denis Bragin2,3, Evgenii Rogozhin1

  • 1Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russia.

Research Square
|July 10, 2026
PubMed

Insights

Early complications after decompressive craniectomy in pediatric severe traumatic brain injury patients are common, particularly hemorrhage. Higher intracranial pressure before and during surgery is linked to these adverse events.

Area of Science:

  • Neurosurgery
  • Pediatric Traumatology
  • Critical Care Medicine

Background:

  • Decompressive craniectomy (DC) is a critical intervention for refractory intracranial hypertension in pediatric severe traumatic brain injury (sTBI).
  • Characterizing early neurosurgical complications and their predictors, especially intracranial pressure (ICP) burden, post-DC in children is crucial but inconsistently defined.

Purpose of the Study:

  • To investigate the incidence and predictors of early postoperative neurosurgical complications following DC in pediatric sTBI.
  • To evaluate the association of pre- and intraoperative ICP burden with these complications.

Main Methods:

  • Retrospective cohort study of pediatric patients (<18 years) with sTBI (GCS 3-8) undergoing DC.
  • Defined early complications (within 7 days or before discharge) including hemorrhage, CNS infection, wound dehiscence, and CSF leak.
  • Analyzed associations with injury severity, imaging, and ICP variables (mean intraoperative ICP, duration of ICP >20 mmHg before DC).

Main Results:

  • 39.8% of 83 pediatric patients experienced at least one early complication.
  • Secondary intracranial hemorrhage was the most frequent complication (34.9%).
  • Patients with complications showed significantly higher intraoperative ICP and longer duration of elevated ICP (>20 mmHg) prior to DC.

Conclusions:

  • Early postoperative complications are frequent after pediatric DC, with hemorrhage being predominant.
  • Increased ICP burden before and during DC is associated with a higher risk of these complications.
  • The study underscores the need for meticulous dural closure techniques and vigilant postoperative monitoring to mitigate risks like CSF leak and CNS infection.
Abstract

Keywords:
Decompressive CraniectomyIntracranial PressurePediatric Neurocritical CarePostoperative ComplicationsTraumatic Brain Injury

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