Abstract
Introduction
Decompressive craniectomy remains a controversial procedure in the treatment of raised intracranial pressure (ICP) associated with post-traumatic brain swelling. Although there are a number of studies in adults published in the literature on this topic, most commonly as a salvage procedure in the treatment of refractory raised ICP, there are few that investigate it primarily in children with head injuries.
Aim
Our aim was to report the experience with decompressive craniotomy in children with severe traumatic brain injury (TBI) at the Red Cross Children's' hospital.
Methods
This study reports five patients in whom decompressive craniectomy or craniotomy with duraplasty was used as an early, aggressive treatment of raised ICP causing secondary acute neurological deterioration after head injury. The rationale was to save the patient from acute cerebral herniation and to prevent exposure to a prolonged course of intracranial hypertension.
Results
All patients benefited from the procedure, demonstrating control of ICP, radiological improvement and neurological recovery. Long-term follow-up was available, with outcome assessed at a minimum of 14 months after injury.
Discussion
The early approach to the use of decompressive craniotomy in the treatment of severe traumatic brain injury (TBI) with secondary deterioration due to raised ICP is emphasised. A favourable outcome was achieved in all of the cases presented. The potential benefit of decompressive craniectomy/craniotomy in the management of children with severe TBI is discussed.
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References
Alberico AM, Ward JD, Choi SC, Marmarou A, Young HF (1987) Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 67:648–656
Aldrich EF, Eisenberg HM, Saydjari C, Luerssen TG, Foulkes MA, Jane JA, Marshall LF, Marmarou A, Young HF (1992) Diffuse brain swelling in severely head-injured children. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 76:450–454
Alexander E, Ball MR, Laster DW (1987) Subtemporal decompression: radiological observations and current surgical experience. Br J Neurosurg 1:427–433
Berger MS, Pitts LH, Lovely M, Edwards MSB, Bartkowski HM (1985) Outcome from severe head injury in children and adolescents. J Neurosurg 62:194–199
Bullock R, Chestnut R, Clifton G, Ghajar, Marion D, Narayan R Newell D, Pitts L, Rosner M, Wilberger J (1996) Guidelines for the management of head injury. Brain Trauma Foundation. Eur J Emerg Med 3:109–127
Carter BS, Ogilvy CS, Candia GJ, Rosas HD, Buonanno F (1997) One year outcome after decompressive surgery for massive nondominant hemispheric infarction. Neurosurgery 40:1168–1176
Cho D, Wang Y, Chi C (1995) Decompressive craniotomy for acute shaken/impact baby syndrome. Pediatr Neurosurg 23:192–198
Clark K, Nash T, Hutchison GC (1968) The failure of circumferential craniotomy in acute traumatic cerebral swelling. J Neurosurg 29:367–371
Cooper PR, Rovit RL, Ranshoff J (1976) Hemicraniectomy in the treatment of acute subdural hematoma: a re-appraisal. Surg Neurol 5:25–28
Cooper PR, Hagler H, Clark WK, Barnett P (1979) Enhancement of experimental cerebral edema after decompressive craniectomy: implications for the management of severe head injuries. Neurosurgery 4:296–300
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 50:1050–1059
Cruz J (1996) Adverse effects of pentobarbital on cerebral venous oxygenation of comatose patients with acute traumatic brain swelling: relationship to outcome. J Neurosurg 85:758–761
Cruz J, Miner ME, Allen SJ, Alves WM, Gennarelli TA (1990) Continuous monitoring of cerebral oxygenation in acute brain injury: injection of mannitol during hyperventilation. J Neurosurg 73:725–730
Doerfler A, Forsting M, Reith W, Staff C, Heiland S, Schabitz W, Von Kummer R, Hacke W, Sartor K (1996) Decompressive craniectomy in a rat model of malignant cerebral hemispheric stroke: experimental support for an aggressive therapeutic approach. J Neurosurg 85:853–859
Forsting M, Reith W, Schabitz W, Heiland S, von Kummer R, Hacke W, Sartor K (1995) Decompressive craniectomy for cerebral infarction: an experimental study in rats. Stroke 26:259–263
Gaab M, Knoblich E, Fuhrmeister U, Pflughaupt KW, Dietrich K (1979) Comparison of the effects of surgical decompression and resection of local edema in the therapy of experimental brain trauma. Investigation of ICP, EEG and cerebral metabolism in cats. Childs Brain 5:484–498
Gaab MR, Rittierodt M, Lorenz M, Heissler HE (1990) Traumatic brain swelling and operative decompression: a prospective investigation. Acta Neurochir Suppl 51:326–328
Gower DJ, Lee KS, McWhorter JM (1988) Role of subtemporal decompression in severe closed head injury. Neurosurgery 23:417–422
Guerra WK, Gaab MR, Dietz H, Mueller J, Piek J, Fritsh MJ (1999) Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 90:187–196
Hase U, Reulen H-J, Meing G, Schurman K (1978) The influence of the decompressive operation on the intracranial pressure and the pressure-volume relation in patients with severe head injuries. Acta Neurochir 45:1–13
Hatashita S, Hoff JT (1987) The effects of craniectomy on the biomechanics of normal brain. J Neurosurg 67:573–578
Hatashita S, Koike J, Sonokawa T, Ishi S (1985) Cerebral edema associated with craniectomy and arterial hypertension. Stroke 16:661–668
Hieu PD, Sizun J, Person H, Besson G (1996) The place of decompressive surgery in the treatment of uncontrollable post-traumatic intracranial hypertension in children. Childs Nerv Syst 12:270–275
Jennet B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484
Johnson DL, Krishnamurthy S (1998) Severe pediatric head injury: myth, magic, and actual fact. Pediatr Neurosurg 28:167–172
Juul N, Morris GF, Marshall SB, The Executive Committee of the International Selfotel Trial, Marshall LF (2000) Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. J Neurosurg 92:1–6
Kaufmann AM, Cardoso ER (1992) Aggravation of vasogenic cerebral edema by multiple-dose mannitol. J Neurosurg 77:584–589
Kerr FWL (1968) Radical decompression and dural grafting in severe cerebral edema. Mayo Clin Proc 43:852–864
Kjellberg RA, Prieto A (1971) Bifrontal decompressive craniotomy for massive cerebral edema. J Neurosurg 34:488–493
Marshall L, Gautille T, Klauber M, Eisenberg HM, Jane J, Luerssen TG, Marmarou A, Foulkes MA (1991) The outcome of severe closed head injury. J Neurosurg 75:S28–S36
Marshall LF, Bowers Marshall S, Klauber MR, van Berkum Clark M, Eisenberg HM, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1991) A new classification of head injury based on computerized tomography. J Neurosurg 75:S14–S20
Marshall LF, Smith RW, Shapiro HM (1979) The outcome with aggressive treatment in severe head injuries. I. The significance of intracranial pressure monitoring. J Neurosurg 50:20–25
Meyer P, Legros C, Orliaguet G (1999) Critical care management of neurotrauma in children: new trends and perspectives. Childs Nerv Syst 15:732–739
Moody RA, Ruamsuke S, Mullan SF (1968) An evaluation of decompression in experimental head injury. J Neurosurg 29:586–590
Munch E, Horn P, Schurer L, Piepgras A, Torsten P, Smiedeck P (2000) Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery 47:315–323
Pillai S, Praharaj SS, Mohanty A, Sastri Kolluri VR (2001) Prognostic factors in children with severe diffuse brain injuries: a study of 74 patients. Pediatr Neurosurg 34:98–103
Polin RS, Shaffrey ME, Bogaev CA, Tisdale N, Germanson T, Bocchicchio B, Jane JA (1997) Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41:84–94
Pople IK, Mulbauer MS, Sanford RA, Kirk E (1995) Results and complications of intracranial pressure monitoring in 303 children. Pediatr Neurosurg 23:64–67
Prasad MR, Ewing-Cobbs L, Swank PR, Kramer L (2002) Predictors of outcome following traumatic brain injury in young children. Pediatr Neurosurg 36:64–74
Rekate H (2001) Head injuries: management of primary injuries and prevention of secondary damage. A consensus conference on pediatric neurosurgery. Childs Nerv Syst 17:632–634
Rengarachy SS, Barnitzky S, Morantz RA, Arjunan K, Jeffries B (1981) Hemicraniectomy for acute massive cerebral infarction. Neurosurgery 8:321–328
Rieke K, Schwab S, Krieger D, von Kummer R, Aschoff A, Schuchardt V, Hacke W (1995) Decompressive surgery in space-occupying hemispheric infarction: results of an open, prospective trial. Crit Care Med 23:1576–1587
Rinaldi A, Mangiola A, Anile C, Maira G, Amante P, Ferraresi A (1990) Hemodynamic effects of decompressive craniectomy in cold-induced brain edema. Acta Neurochir Suppl 51:394–396
Ropper A (1986) Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass. N Engl J Med 314:953–958
Ross DA, Olsen WL, Ross AM, Andrews BT, Pitts LH (1989) Brain shift, level of consciousness, and restoration of consciousness in patients with acute intracranial hematoma. J Neurosurg 71:498–502
Shapiro K, Marmorou A (1982) Clinical applications of the pressure-volume index in treatment of pediatric head injuries. J Neurosurg 56:819–825
Shapiro K, Fried A, Takei F, Kohn I (1985) Effect of the skull and dura on neural axis pressure-volume relationships and CSF hydrodynamics. J Neurosurg 63:76–81
Simma B, Tscharre A, Hejazi N, Krasznai L, Fae P (2002) Neurologic outcome after decompressive craniectomy in children (correspondence). Intensive Care Med 28:1000
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. Childs Nerv Syst 17:154–162
Van Dongen KJ, Braakman R, Jan Gelpke G (1983) The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 59:951–957
Venes JL, Collins WF (1975) Bifrontal decompressive craniectomy in the management of head trauma. J Neurosurg 42:429–433
Whitfield PC, Patel H, Hutchinson PJA, Czosnyka M, ParryD, Menon D, Pickard JD, Kirkpatrick PJ (2001) Bifrontal decompressive craniectomy in the management of posttraumatic intracranial hypertension. Br J Neurosurg 15:500–507
Yoo D, Kim D, Cho K, Huh P, Park C, Kang J (1999) Ventricular pressure monitoring during bilateral compression with dural expansion. J Neurosurg 91:953–959
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Figaji, A.A., Fieggen, A.G. & Peter, J.C. Early decompressive craniotomy in children with severe traumatic brain injury. Childs Nerv Syst 19, 666–673 (2003). https://doi.org/10.1007/s00381-003-0804-3
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DOI: https://doi.org/10.1007/s00381-003-0804-3