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The role of decompressive craniectomy in children with severe traumatic brain injury

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Objective

Severe traumatic brain injury (TBI) remains the leading cause of death in children. The present study analyses the outcome of children after severe TBI treated by decompressive craniectomy (DC) due to elevated intracranial pressure (ICP) in a single centre.

Methods

Fifty-six consecutive children (age < 16 years) were treated for severe TBI at our institution between 2001 and 2011. For study purposes, children with severe generalized traumatic brain swelling without concomitant mass lesion were further analysed. Descriptive statistics were used to report clinical conditions as well as outcome measurements after conservative treatment only in comparison to secondary decompressive craniectomy.

Results

Of 56 children, a total of eight children presented with generalized and progressive traumatic brain swelling and impending brain herniation. Four children were treated conservatively following standardized local protocol for anti-oedematous management, with ICP amenable to intensified therapy. Four children required decompressive surgery due to progressive oedema refractory to intensified conservative management. Children receiving secondary DC had a longer stay in the intensive care unit as well as a longer average time of assisted ventilation compared to children treated conservatively. Concomitant injuries were more severe in the DC subgroup. Yet, Glasgow Outcome Scale was equally distributed in both groups.

Conclusion

In children with refractory ICP conditions due to severe TBI, decompressive surgery might lead to a similar favourable outcome compared to children in whom ICP can be controlled only by conservative management. Timing of surgery depends on the neurological deterioration of the patients and a continuous ICP monitoring.

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Conflict of interest

Nicolai El Hindy, Klaus P. Stein, Vincent Hagel, Philipp Dammann, Ulrich Sure, and Oliver Mueller declare no conflict of interest.

Ethical approval

The study protocol was approved by our ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany

    N. El Hindy, K. P. Stein, V. Hagel, P. Dammann, U. Sure & O. Mueller

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  1. N. El Hindy
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  2. K. P. Stein
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  3. V. Hagel
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Correspondence to N. El Hindy.

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El Hindy, N., Stein, K.P., Hagel, V. et al. The role of decompressive craniectomy in children with severe traumatic brain injury. Eur J Trauma Emerg Surg 40, 481–487 (2014). https://doi.org/10.1007/s00068-013-0337-8

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  • DOI: https://doi.org/10.1007/s00068-013-0337-8

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