Decompressive Craniectomy for Traumatic Intracranial Hypertension in Children.

Abstract

OBJECTIVES\nDecompressive craniectomy (DC) for control of refractory intracranial pressure (ICP) elevations remains a controversial procedure because of its invasiveness and lack of clearly defined indications, the absence of an established surgical technique, the variability of its outcomes, and the significant risk of complications.\n\n\nAIM\nThe purpose of this study was to identify factors for unfavorable outcomes after DC in children with a severe traumatic brain injury (TBI).\n\n\nMETHODS\nA longitudinal investigation of correlations was carried out in 64 children (mean age\xa0±\xa04.8\xa0years) with severe TBI and a Glasgow Coma Scale (GCS) score of 6\xa0±\xa02 on admission. The follow-up period was 6\xa0months.\n\n\nRESULTS\nThere was good recovery (with a Glasgow Outcome Scale (GOS) score of 4-5) in 45.3% of cases, severe disability in 31.0% of cases (with a GOS score of 3); and a GOS score of 1-2 in 23.4% of cases. Twelve patients (18.7%) died. Unfavorable prognostic signs were a GCS score < 5 (P = 0.0003); dilated, unreactive pupils (P < 0.05); and ICP >40 mmHg (P\xa0=\xa00.0003; P\xa0<\xa00.05). ICP characteristics appeared to be the most sensitive predictor of outcomes after secondary DC (P\xa0<\xa00.05).\n\n\nCONCLUSION\nDC may be effective in preventing dislocation syndrome but futile in cases of cerebral herniation. Outcomes after DC are determined by the severity of the primary and secondary brain injuries.