Article
Decompressive craniectomy in pediatric patients – Single center series and systematic review
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Authors
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Patrick Schuss
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Neurochirurgie, Frankfurt am Main
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Erdem Güresir
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Neurochirurgie, Frankfurt am Main
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Volker Seifert
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Neurochirurgie, Frankfurt am Main
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Hartmut Vatter
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Neurochirurgie, Frankfurt am Main
| Published: | May 20, 2011 |
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Outline
Text
Introduction: Decompressive craniectomy (DC) is performed as a life-saving procedure in patients suffering from intractably elevated intracranial pressure following traumatic brain injury (TBI), bleeding, cerebral infarction or brain swelling of other etiologies. In the pediatric subgroup, DC is still controversially discussed. We therefore analyzed our institutional data and performed a review of literature.
Materials and methods: Between April 2000 and December 2009 we performed 37 DCs in 34 pediatric patients (age 0-18 years). Patients were stratified according to the indication for DC: (1) TBI, (2) cerebral infarction, (3) intracerebral hemorrhage (ICH), (4) subarachnoid hemorrhage (SAH) and (5) other non-traumatic reasons. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months (mRS 0–2 favorable vs. mRS 3–6 unfavorable). MEDLINE was searched for studies or reports of DC in pediatric patients to gain a larger population.
Results: Literature data, including the current series revealed a total of 172 pediatric patients. According to the underlying pathology, 136 procedures (79.1%) were performed due to TBI, 13 (7.5%) due to cerebral infarction, 5 (2.9%) due to ICH, 2 (1.2%) due to SAH, and 16 procedures (9.3%) due to other reasons. Overall 106 of 172 patients achieved a favorable outcome (62%). Favorable outcome was achieved in 25 of 36 patients without TBI vs. 81 of 136 patients with TBI (69% vs. 60%). Patients without signs of cerebral herniation achieved better outcome than patients with unilateral or bilateral dilated pupils (73% vs. 60% vs. 45%).
Conclusion: The current data indicates that decompressive craniectomy in children with traumatic or non-traumatic brain swelling might be warranted, regardless of the underlying etiology. Despite mydriasis, favorable outcome might be achieved in a significant number of pediatric patients. Nevertheless, careful individual decision making is needed for each patient, especially when signs of cerebral herniation have persisted for a long time.
