Child's Nervous System

, Volume 35, Issue 9, pp 1507–1515 | Cite as

Decompressive craniectomy for severe traumatic brain injury in children: analysis of long-term neuropsychological impairment and review of the literature

  • Matheus Fernando Manzolli BallesteroEmail author
  • Luciano Lopes Furlanetti
  • Lucas Pires Augusto
  • Pedro Henrique Carmona Chaves
  • Marcelo Volpon Santos
  • Ricardo Santos de Oliveira
Original Article



The effectiveness of decompressive craniectomy (DC) in the context of neurocritical care in adult patients has been recently under debate. The aim of our study was to evaluate the impact of decompressive craniectomy in severe traumatic brain injury (TBI) in children, focusing on short and long-term neurological and neuropsychological outcomes.


Retrospective review of the medical records of children admitted at a level I trauma center, between January 2012 and December 2015, submitted to DC due to severe TBI. Additionally, an extensive review of literature on this subject was carried out.


Sixteen patients underwent DC for TBI at our institution during the evaluated period. 62.5% were males and the mean age was 12 years. Road traffic accident (RTA) was the main mechanism of trauma (62.5%). Average Glasgow Coma Scale (GCS) at admission was 5.2, whereas 75% of the patients presented with pathological pupillary reaction. Initial computed tomography (CT) showed skull fractures in 62.5% and acute subdural hemorrhage (ASH) in 56.3% of the patients. The mean intracranial pressure (ICP) was 27.2 mmHg prior to surgery, and the mean time window between admission and DC was 36.3 h. Unilateral DC was performed in 68.8% of the cases. The average Glasgow Outcome Scale (GOS) at 6-month follow-up was 3.7, whereas 70% of the survivors presented good recovery (GOS 4–5). Abnormal pupillary reaction at hospital admission increased 3-fold the risk of long-term neuropsychological disturbances. Follow-up evaluation revealed cognitive abnormality in 55.6% of the patients. The overall mortality at 6-month follow-up was 37.5%.


The present study indicates towards a potential benefit of DC in children with severe TBI; nevertheless, our data demonstrated a high incidence of neuropsychological impairment in the long-term follow-up. Psychological and cognitive assessment should be computed in prognosis evaluation in future prospective studies.


Decompressive craniectomy Traumatic brain injury Children Psychological evaluation 


Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Matheus Fernando Manzolli Ballestero
    • 1
    • 2
    Email author
  • Luciano Lopes Furlanetti
    • 3
  • Lucas Pires Augusto
    • 1
  • Pedro Henrique Carmona Chaves
    • 1
  • Marcelo Volpon Santos
    • 1
  • Ricardo Santos de Oliveira
    • 1
  1. 1.Division of Pediatric Neurosurgery, Department of Surgery and AnatomyUniversity Hospital, Ribeirão Preto Medical School, University of São PauloRibeirão PretoBrazil
  2. 2.Department of MedicineFederal University of São CarlosSão CarlosBrazil
  3. 3.Department of NeurosurgeryKing’s College Hospital NHS Foundation TrustLondonUK

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