Child's Nervous System

, Volume 23, Issue 11, pp 1331–1335 | Cite as

Intracranial pressure and cerebral oxygenation changes after decompressive craniectomy in a child with traumatic brain swelling

  • A. A. FigajiEmail author
  • A. G. Fieggen
  • S. J. I. Sandler
  • A. C. Argent
  • P. D. Le Roux
  • J. C. Peter
Case Report


Case report

The authors present the case of a 5-year-old child with severe traumatic brain injury in whom decompressive hemicraniectomy was performed for progressive increased intracranial pressure (ICP) unresponsive to medical treatment. Data from ICP and cerebral tissue oxygenation monitoring in the contralateral hemisphere were recorded, which demonstrated the immediate and delayed mechanical and physiological changes occurring after bony and dural decompression.


The role of the procedure and that of the monitoring approach are discussed.


Decompressive craniectomy Cerebral tissue oxygenation Raised intracranial pressure Monitoring Traumatic brain injury Children 


  1. 1.
    Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM (2006) Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 104:469–479PubMedGoogle Scholar
  2. 2.
    Clark K, Nash T, Hutchison GC (1968) The failure of circumferential craniotomy in acute traumatic cerebral swelling. J Neurosurg 29:367–371PubMedGoogle Scholar
  3. 3.
    Cooper PR, Rovit RL, Ranshoff J (1976) Hemicraniectomy in the treatment of acute subdural hematoma: a re-appraisal. Surg Neurol 5:25–28PubMedGoogle Scholar
  4. 4.
    Coplin WM, Cullen NK, Policheria PS, Vinas FC, Wilseck JM, Zafonte RD, Rengachary SS (2001) Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. J Trauma 50:1050–1059PubMedGoogle Scholar
  5. 5.
    Figaji AA, Fieggen AG, Peter JC (2003) Early decompressive craniotomy in children with severe traumatic brain injury. Child’s Nerv Syst 19:666–673CrossRefGoogle Scholar
  6. 6.
    Figaji AA, Fieggen AG, Argent A, Peter JC (2006) Surgical treatment for “brain compartment syndrome” in children with severe head injury. S Afr Med J 96:969–975PubMedGoogle Scholar
  7. 7.
    Graham DI, Ford I, Adams JH, Doyle D, Teasdale GM, Lawrence AE, McLellan DR (1989) Ischaemic brain damage is still common in fatal non-missile head injury. J Neurol Neurosurg Psychiatry 52:346–350PubMedGoogle Scholar
  8. 8.
    Jaeger M, Soehle M, Meixensberger J (2003) Effects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension. J Neurol Neurosurg Psychiatry 74:513–515PubMedCrossRefGoogle Scholar
  9. 9.
    Johnson DL, Krishnamurthy S (1998) Severe pediatric head injury: myth, magic, and actual fact. Pediatr Neurosurg 28:167–172PubMedCrossRefGoogle Scholar
  10. 10.
    Josan VA, Sgouros S (2006) Early decompressive craniectomy may be effective in the treatment of refractory intracranial hypertension after traumatic brain injury. Child’s Nerv Syst 22:1268–1274CrossRefGoogle Scholar
  11. 11.
    Marshall RS (2004) The functional relevance of cerebral hemodynamics: why blood flow matters to the injured and recovering brain. Curr Opin Neurol 17:705–709PubMedCrossRefGoogle Scholar
  12. 12.
    Menzel M, Doppenberg EM, Zauner A, Soukup J, Reinert MM, Bullock R (1999) Increased inspired oxygen concentration as a factor in improved brain tissue oxygenation and tissue lactate levels after severe human head injury. J Neurosurg 91:1–10PubMedCrossRefGoogle Scholar
  13. 13.
    Panerai RB, Kerins V, Fan L, Yeoman PM, Hope T, Evans DH (2004) Association between dynamic cerebral autoregulation and mortality in severe head injury. Br J Neurosurg 18:471–479PubMedCrossRefGoogle Scholar
  14. 14.
    Reinert M, Barth A, Rothen HU, Schaller B, Takala J, Seiler RW (2003) Effects of cerebral perfusion pressure and increased fraction of inspired oxygen on brain tissue oxygen, lactate and glucose in patients with severe head injury. Acta Neurochir (Wien) 145:341–349Google Scholar
  15. 15.
    Reithmeier T, Lohr M, Pakos P, Ketter G, Ernestus R-I (2005) Relevance of ICP and ptiO2 for indication and timing of decompressive craniectomy in patients with malignant brain edema. Acta Neurochir 147:947–952CrossRefGoogle Scholar
  16. 16.
    Stiefel MF, Heur GG, Smith MJ, LeRoux PD et al (2004) Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension. J Neurosurg 101:241–247PubMedGoogle Scholar
  17. 17.
    Stiefel MF, Spiotta A, Gracias VH, Garuffe A, Goldberg AH, Guillamondegui OD, Maloney-Wilensky E, Bloom S, Grady MS, Le Roux P (2005) Reduced mortality in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg 103:805–811PubMedGoogle Scholar
  18. 18.
    Stiefel MF, Udoetuk JD, Spiotta AM, Gracias VH, Goldberg A, Maloney-Willenskey E, Bloom S, Le Roux PD (2006) Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg 105:568–575PubMedGoogle Scholar
  19. 19.
    Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, Wallace D, Henning R, Tibbals J (2001) A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Child’s Nerv Syst 17:154–162CrossRefGoogle Scholar
  20. 20.
    Valadka AB, Gopinath SP, Contant CF, Uzura M, Robertson CS (1998) Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med 26:1576–1581PubMedCrossRefGoogle Scholar
  21. 21.
    Valadka AB, Hlatky R, Furuya Y, Robertson CS (2002) Brain tissue PO2: correlation with cerebral blood flow. Acta Neurochir Suppl 81:299–301PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • A. A. Figaji
    • 1
    Email author
  • A. G. Fieggen
    • 1
  • S. J. I. Sandler
    • 1
  • A. C. Argent
    • 2
  • P. D. Le Roux
    • 3
  • J. C. Peter
    • 1
  1. 1.Division of Neurosurgery, Red Cross Childrens Hospital, Institute for Child HealthUniversity of Cape TownCape TownSouth Africa
  2. 2.Division of Pediatric Critical Care, Red Cross Childrens Hospital, Institute for Child HealthUniversity of Cape TownCape TownSouth Africa
  3. 3.Department of Neurosurgery, The Hospital of the University of PennsylvaniaUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations