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Life-saving decompressive craniectomy for diffuse cerebral edema during an episode of new-onset diabetic ketoacidosis

Case report and review of the literature

  • Case Report
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Diabetic ketoacidosis (DKA), a well-known complication of diabetes mellitus, is associated with severe diffuse cerebral edema leading to brain herniation and death. Survival from an episode of symptomatic cerebral edema has been associated with debilitating neurological sequelae, including motor deficits, visual impairment, memory loss, seizures, and persistent vegetative states. A review of the literature reveals scant information regarding the potential surgical options for these cases. The authors present their case in which they used a craniectomy to treat this life-threatening condition.

Methods

After reportedly suffering nausea and vomiting, a 12-year-old male presented to the emergency room with lethargy and was diagnosed with acute DKA. After appropriate treatment, the patient became comatose. A CT scan revealed diffuse cerebral edema. To decrease intracranial pressure and prevent further progression of brain herniation, a bifrontal decompressive craniectomy with duraplasty was performed.

Results

The patient’s neurological function gradually improved, and he returned to school and his regular activities with only minimal cognitive deficits.

Conclusion

Given the high mortality and morbidity associated with DKA-related edema, we believe decompressive craniectomy should be considered for malignant cerebral edema and herniation syndrome.

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References

  1. Jabbar A, Farooqui K, Habib A, Islam N, Haque N, Akhter J (2004) Clinical characteristics and outcomes of diabetic ketoacidosis in Pakistani adults with Type 2 diabetes mellitus. Diabet Med 21:920–923

    Article  PubMed  CAS  Google Scholar 

  2. Sapru A, Gitelman SE, Bhatia S, Dubin RF, Newman TB, Flori H (2005) Prevalence and characteristics of type 2 diabetes mellitus in 9–18 year-old children with diabetic ketoacidosis. J Pediatr Endocrinol Metab 18:865–872

    PubMed  Google Scholar 

  3. Dunger DB, Sperling MA, Acerini CL, Bohn DJ, Daneman D, Danne TP, Glaser NS, Hanas R, Hintz RL, Levitsky LL, Savage MO, Tasker RC, Wolfsdorf JI (2004) European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics 113:e133–e140

    Article  PubMed  Google Scholar 

  4. RH DES, Dyer WW (1936) Cerebral lesions in uncomplicated fatal diabetic acidosis. Am J Med Sci 192:360–365

    Article  Google Scholar 

  5. Glaser N (2009) Cerebral injury and cerebral edema in children with diabetic ketoacidosis: could cerebral ischemia and reperfusion injury be involved? Pediatr Diabetes 10:534–541

    Article  PubMed  CAS  Google Scholar 

  6. Edge JA, Hawkins MM, Winter DL, Dunger DB (2001) The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child 85:16–22

    Article  PubMed  CAS  Google Scholar 

  7. Marcin JP, Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, Kaufman F, Quayle K, Roback M, Malley R, Kuppermann N (2002) Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. J Pediatr 141:793–797

    Article  PubMed  Google Scholar 

  8. Rosenbloom AL (1990) Intracerebral crises during treatment of diabetic ketoacidosis. Diab Care 13:22–33

    Article  CAS  Google Scholar 

  9. Mahoney CP, Vlcek BW, DelAguila M (1999) Risk factors for developing brain herniation during diabetic ketoacidosis. Pediatr Neurol 21:721–727

    Article  PubMed  CAS  Google Scholar 

  10. Glaser N, Barnett P, McCaslin I, Nelson D, Trainor J, Louie J, Kaufman F, Quayle K, Roback M, Malley R, Kuppermann N (2001) Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med 344:264–269

    Article  PubMed  CAS  Google Scholar 

  11. Lawrence SE, Cummings EA, Gaboury I, Daneman D (2005) Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. J Pediatr 146:688–692

    Article  PubMed  Google Scholar 

  12. Eskandar EN, Weller SJ, Frim DM (1997) Hydrocephalus requiring urgent external ventricular drainage in a patient with diabetic ketoacidosis and cerebral edema: case report. Neurosurgery 40:836–838, discussion 838–839

    Article  PubMed  CAS  Google Scholar 

  13. Wood EG, Go-Wingkun J, Luisiri A, Aceto T Jr (1990) Symptomatic cerebral swelling complicating diabetic ketoacidosis documented by intraventricular pressure monitoring: survival without neurologic sequela. Pediatr Emerg Care 6:285–288

    Article  PubMed  CAS  Google Scholar 

  14. Koul PB (2009) Diabetic ketoacidosis: a current appraisal of pathophysiology and management. Clin Pediatr (Phila) 48:135–144

    Article  Google Scholar 

  15. Muir AB, Quisling RG, Yang MC, Rosenbloom AL (2004) Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification. Diab Care 27:1541–1546

    Article  Google Scholar 

  16. McManus ML, Churchwell KB, Strange K (1995) Regulation of cell volume in health and disease. N Engl J Med 333:1260–1266

    Article  PubMed  CAS  Google Scholar 

  17. Strange K, Morrison R (1992) Volume regulation during recovery from chronic hypertonicity in brain glial cells. Am J Physiol 263:C412–C419

    PubMed  CAS  Google Scholar 

  18. Strange K (1992) Regulation of solute and water balance and cell volume in the central nervous system. J Am Soc Nephrol 3:12–27

    PubMed  CAS  Google Scholar 

  19. Mc DM, Wolf AV, Steer A (1955) Osmotic volumes of distribution; idiogenic changes in osmotic pressure associated with administration of hypertonic solutions. Am J Physiol 180:545–558

    Google Scholar 

  20. Levin DL (2008) Cerebral edema in diabetic ketoacidosis. Pediatr Crit Care Med 9:320–329

    Article  PubMed  Google Scholar 

  21. Duck SC, Wyatt DT (1988) Factors associated with brain herniation in the treatment of diabetic ketoacidosis. J Pediatr 113:10–14

    Article  PubMed  CAS  Google Scholar 

  22. Sheffer Z, Peleg E, Landau-Salzberg M, Rosenthal T (1991) Atrial natriuretic peptide in diabetic patients before and after control of blood sugar level. J Cardiovasc Pharmacol 18:878–881

    Article  PubMed  CAS  Google Scholar 

  23. Edge JA (2000) Cerebral oedema during treatment of diabetic ketoacidosis: are we any nearer finding a cause? Diabetes/Metab Res Rev 16:316–324

    Article  CAS  Google Scholar 

  24. Lam TI, Wise PM, O’Donnell ME (2009) Cerebral microvascular endothelial cell Na/H exchange: evidence for the presence of NHE1 and NHE2 isoforms and regulation by arginine vasopressin. Am J Physiol Cell Physiol 297:C278–C289

    Article  PubMed  CAS  Google Scholar 

  25. O’Donnell ME, Duong V, Suvatne J, Foroutan S, Johnson DM (2005) Arginine vasopressin stimulation of cerebral microvascular endothelial cell Na–K–Cl cotransporter activity is V1 receptor and [Ca] dependent. Am J Physiol Cell Physiol 289:C283–292

    Article  PubMed  Google Scholar 

  26. Lam TI, Anderson SE, Glaser N, O’Donnell ME (2005) Bumetanide reduces cerebral edema formation in rats with diabetic ketoacidosis. Diabetes 54:510–516

    Article  PubMed  CAS  Google Scholar 

  27. Pedersen SF, O’Donnell ME, Anderson SE, Cala PM (2006) Physiology and pathophysiology of Na+/H + exchange and Na+–K+–2Cl−cotransport in the heart, brain, and blood. Am J Physiol Regul Integr Comp Physiol 291:R1–R25

    Article  PubMed  CAS  Google Scholar 

  28. Pasantes-Morales H, Cruz-Rangel S (2010) Brain volume regulation: osmolytes and aquaporin perspectives. Neuroscience 168(4):871–874

    Article  PubMed  CAS  Google Scholar 

  29. Glaser NS, Wootton-Gorges SL, Marcin JP, Buonocore MH, Dicarlo J, Neely EK, Barnes P, Bottomly J, Kuppermann N (2004) Mechanism of cerebral edema in children with diabetic ketoacidosis. J Pediatr 145:164–171

    Article  PubMed  Google Scholar 

  30. Yildizdas D, Altunbasak S, Celik U, Herguner O (2006) Hypertonic saline treatment in children with cerebral edema. Indian Pediatr 43:771–779

    PubMed  CAS  Google Scholar 

  31. Sherry NA, Levitsky LL (2008) Management of diabetic ketoacidosis in children and adolescents. Paediatr Drugs 10:209–215

    Article  PubMed  Google Scholar 

  32. Tasker RC, Lutman D, Peters MJ (2005) Hyperventilation in severe diabetic ketoacidosis. Pediatr Crit Care Med 6:405–411

    Article  PubMed  Google Scholar 

  33. Marcin JP, Glaser N, Kuppermann N (2005) Ventilation in pediatric diabetic ketoacidosis—not too much, but not too little. Pediatr Crit Care Med 6:489–490

    Article  PubMed  Google Scholar 

  34. Shrier DA, Shibata DK, Wang HZ, Numaguchi Y, Powers JM (1999) Central brain herniation secondary to juvenile diabetic ketoacidosis. AJNR Am J Neuroradiol 20:1885–1888

    PubMed  CAS  Google Scholar 

  35. Lindegaard KF, Folkestad O, Moen J, Sundseth J (2008) Hemicraniectomy in acute brain infarction. Tidsskr Nor Laegeforen 128:303–307

    PubMed  Google Scholar 

  36. Yao Y, Mao Y, Zhou L (2007) Decompressive craniectomy for massive cerebral infarction with enlarged cruciate duraplasty. Acta Neurochir (Wien) 149:1219–1221, discussion 1221

    Article  CAS  Google Scholar 

  37. Nobre MC, Monteiro M, Albuquerque AC, Veloso AT, Mendes VA, Silveira MF, Souza Filho LD, Silva MJ, Bicalho GV (2007) Decompressive craniectomy for treatment of intracranial hypertension secondary to large ischemic cerebral infarction: analysis of 34 cases. Arq Neuropsiquiatr 65:107–113

    PubMed  Google Scholar 

  38. Cagavi F, Tekkok IH, Akpinar G (2005) Malignant cerebral infarction secondary to internal carotid injury in closed head trauma: good outcome with aggressive treatment—a case report. Angiology 56:107–114

    Article  PubMed  Google Scholar 

  39. Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB (2009) Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 8:326–333

    Article  PubMed  Google Scholar 

  40. Reddy AK, Saradhi V, Panigrahi M, Rao TN, Tripathi P, Meena AK (2002) Decompressive craniectomy for stroke: indications and results. Neurol India 50(Suppl):S66–S69

    PubMed  Google Scholar 

  41. Raffelsieper B, Merten C, Mennel HD, Hedde HP, Menzel J, Bewermeyer H (2002) Decompressive craniectomy for severe intracranial hypertension due to cerebral infarction or meningoencephalitis. Anästhesiol Intensivmed Notfallmed Schmerzther 37:157–162

    Article  PubMed  CAS  Google Scholar 

  42. Doerfler A, Engelhorn T, Forsting M (2001) Decompressive craniectomy for early therapy and secondary prevention of cerebral infarction. Stroke 32:813–815

    Article  PubMed  CAS  Google Scholar 

  43. Koh MS, Goh KY, Tung MY, Chan C (2000) Is decompressive craniectomy for acute cerebral infarction of any benefit? Surg Neurol 53:225–230

    Article  PubMed  CAS  Google Scholar 

  44. Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, Hacke W (1998) Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29:1888–1893

    PubMed  CAS  Google Scholar 

  45. Schwab S, Rieke K, Krieger D, Hund E, Aschoff A, von Kummer R, Hacke W (1995) Craniectomy in space-occupying middle cerebral artery infarct. Nervenarzt 66:430–437

    PubMed  CAS  Google Scholar 

  46. Kondziolka D, Fazl M (1988) Functional recovery after decompressive craniectomy for cerebral infarction. Neurosurgery 23:143–147

    Article  PubMed  CAS  Google Scholar 

  47. Marinkovic I, Strbian D, Pedrono E, Vekovischeva OY, Shekhar S, Durukan A, Korpi ER, Abo-Ramadan U, Tatlisumak T (2009) Decompressive craniectomy for intracerebral hemorrhage. Neurosurgery 65:780–786, 781 following 786; discussion 786

    Article  PubMed  Google Scholar 

  48. Adamo MA, Drazin D, Waldman JB (2009) Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries. J Neurosurg Pediatr 3:334–339

    Article  PubMed  Google Scholar 

  49. Dam Hieu P, 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

    PubMed  CAS  Google Scholar 

  50. Yatsushige H, Takasato Y, Masaoka H, Hayakawa T, Otani N, Yoshino Y, Sumiyoshi K, Sugawara T, Miyawaki H, Aoyagi C, Takeuchi S, Suzuki G (2010) Prognosis for severe traumatic brain injury patients treated with bilateral decompressive craniectomy. Acta Neurochir Suppl 106:265–270

    Article  PubMed  Google Scholar 

  51. Lemcke J, Ahmadi S, Meier U (2010) Outcome of patients with severe head injury after decompressive craniectomy. Acta Neurochir Suppl 106:231–233

    Article  PubMed  CAS  Google Scholar 

  52. Manley GT (2009) Introduction: decompressive craniectomy for trauma and cerebrovascular disease. Neurosurg Focus 26:E1

    Article  PubMed  Google Scholar 

  53. Madikians A, Giza CC (2009) Treatment of traumatic brain injury in pediatrics. Curr Treat Options Neurol 11:393–404

    Article  PubMed  Google Scholar 

  54. Yang XF, Wen L, Shen F, Li G, Lou R, Liu WG, Zhan RY (2008) Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien) 150:1241–1247

    Article  CAS  Google Scholar 

  55. Timofeev I, Czosnyka M, Nortje J, Smielewski P, Kirkpatrick P, Gupta A, Hutchinson P (2008) Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury. J Neurosurg 108:66–73

    Article  PubMed  Google Scholar 

  56. Morgalla MH, Will BE, Roser F, Tatagiba M (2008) Do long-term results justify decompressive craniectomy after severe traumatic brain injury? J Neurosurg 109:685–690

    Article  PubMed  Google Scholar 

  57. Meier U, Ahmadi S, Killeen T, Al-Zain FT, Lemcke J (2008) Long-term outcomes following decompressive craniectomy for severe head injury. Acta Neurochir Suppl 102:29–31

    Article  PubMed  CAS  Google Scholar 

  58. Chibbaro S, Tacconi L (2007) Role of decompressive craniectomy in the management of severe head injury with refractory cerebral edema and intractable intracranial pressure. Our experience with 48 cases. Surg Neurol 68:632–638

    Article  PubMed  Google Scholar 

  59. Timofeev I, Hutchinson PJ (2006) Outcome after surgical decompression of severe traumatic brain injury. Injury 37:1125–1132

    Article  PubMed  CAS  Google Scholar 

  60. Skoglund TS, Eriksson-Ritzen C, Jensen C, Rydenhag B (2006) Aspects on decompressive craniectomy in patients with traumatic head injuries. J Neurotrauma 23:1502–1509

    Article  PubMed  Google Scholar 

  61. 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 96:969–975

    PubMed  CAS  Google Scholar 

  62. 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 104:469–479

    Article  PubMed  Google Scholar 

  63. Jiang JY, Xu W, Li WP, Xu WH, Zhang J, Bao YH, Ying YH, Luo QZ (2005) Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. J Neurotrauma 22:623–628

    Article  PubMed  Google Scholar 

  64. Piek J (2002) Decompressive surgery in the treatment of traumatic brain injury. Curr Opin Crit Care 8:134–138

    Article  PubMed  Google Scholar 

  65. Meier U, Zeilinger FS, Henzka O (2000) The use of decompressive craniectomy for the management of severe head injuries. Acta Neurochir Suppl 76:475–478

    PubMed  CAS  Google Scholar 

  66. De Luca GP, Volpin L, Fornezza U, Cervellini P, Zanusso M, Casentini L, Curri D, Piacentino M, Bozzato G, Colombo F (2000) The role of decompressive craniectomy in the treatment of uncontrollable post-traumatic intracranial hypertension. Acta Neurochir Suppl 76:401–404

    PubMed  Google Scholar 

  67. Guerra WK, Gaab MR, Dietz H, Mueller JU, Piek J, Fritsch MJ (1999) Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 90:187–196

    Article  PubMed  CAS  Google Scholar 

  68. 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 41:84–92, discussion 92–84

    Article  PubMed  CAS  Google Scholar 

  69. Venes JL, Collins WF (1975) Bifrontal decompressive craniectomy in the management of head trauma. J Neurosurg 42:429–433

    Article  PubMed  CAS  Google Scholar 

  70. Guresir E, Schuss P, Vatter H, Raabe A, Seifert V, Beck J (2009) Decompressive craniectomy in subarachnoid hemorrhage. Neurosurg Focus 26:E4

    Article  PubMed  Google Scholar 

  71. Schirmer CM, Hoit DA, Malek AM (2007) Decompressive hemicraniectomy for the treatment of intractable intracranial hypertension after aneurysmal subarachnoid hemorrhage. Stroke 38:987–992

    Article  PubMed  Google Scholar 

  72. Fisher CM, Ojemann RG (1994) Bilateral decompressive craniectomy for worsening coma in acute subarachnoid hemorrhage. Observations in support of the procedure. Surg Neurol 41:65–74

    Article  PubMed  CAS  Google Scholar 

  73. Scozzafava J, Brindley PG, Mehta V, Findlay JM (2007) Decompressive bifrontal craniectomy for malignant intracranial pressure following anterior communicating artery aneurysm rupture: two case reports. Neurocrit Care 6:49–53

    Article  PubMed  Google Scholar 

  74. Keller E, Pangalu A, Fandino J, Konu D, Yonekawa Y (2005) Decompressive craniectomy in severe cerebral venous and dural sinus thrombosis. Acta Neurochir Suppl 94:177–183

    Article  PubMed  CAS  Google Scholar 

  75. Lanterna LA, Gritti P, Manara O, Grimod G, Bortolotti G, Biroli F (2009) Decompressive surgery in malignant dural sinus thrombosis: report of 3 cases and review of the literature. Neurosurg Focus 26:E5

    Article  PubMed  Google Scholar 

  76. Masuhr F, Einhaupl K (2008) Treatment of cerebral venous and sinus thrombosis. Front Neurol Neurosci 23:132–143

    PubMed  CAS  Google Scholar 

  77. Weber J, Spring A (2004) Unilateral decompressive craniectomy in left transverse and sigmoid sinus thrombosis. Zentralbl Neurochir 65:135–140

    Article  PubMed  CAS  Google Scholar 

  78. Gonzalez Rabelino GA, Fons C, Rey A, Roussos I, Campistol J (2008) Craniectomy in herpetic encephalitis. Pediatr Neurol 39:201–203

    Article  PubMed  Google Scholar 

  79. Di Rienzo A, Iacoangeli M, Rychlicki F, Veccia S, Scerrati M (2008) Decompressive craniectomy for medically refractory intracranial hypertension due to meningoencephalitis: report of three patients. Acta Neurochir (Wien) 150:1057–1065, discussion 1065

    Article  Google Scholar 

  80. Adamo MA, Deshaies EM (2008) Emergency decompressive craniectomy for fulminating infectious encephalitis. J Neurosurg 108:174–176

    Article  PubMed  Google Scholar 

  81. Mellado P, Castillo L, Andresen M, Campos M, Perez C, Baudrand R (2003) Decompressive craniectomy in a patient with herpetic encephalitis associated to refractory intracranial hypertension. Rev Med Chile 131:1434–1438

    PubMed  Google Scholar 

  82. Taferner E, Pfausler B, Kofler A, Spiss H, Engelhardt K, Kampfl A, Schmutzhard E (2001) Craniectomy in severe, life-threatening encephalitis: a report on outcome and long-term prognosis of four cases. Intensive Care Med 27:1426–1428

    Article  PubMed  CAS  Google Scholar 

  83. Schwab S, Junger E, Spranger M, Dorfler A, Albert F, Steiner HH, Hacke W (1997) Craniectomy: an aggressive treatment approach in severe encephalitis. Neurology 48:412–417

    PubMed  CAS  Google Scholar 

  84. Kontopoulos V, Foroglou N, Patsalas J, Magras J, Foroglou G, Yiannakou-Pephtoulidou M, Sofianos E, Anastassiou H, Tsaoussi G (2002) Decompressive craniectomy for the management of patients with refractory hypertension: should it be reconsidered? Acta Neurochir (Wien) 144:791–796

    Article  CAS  Google Scholar 

  85. Kilincer C, Asil T, Utku U, Hamamcioglu MK, Turgut N, Hicdonmez T, Simsek O, Ekuklu G, Cobanoglu S (2005) Factors affecting the outcome of decompressive craniectomy for large hemispheric infarctions: a prospective cohort study. Acta Neurochir (Wien) 147:587–594, discussion 594

    Article  CAS  Google Scholar 

  86. Kilincer C, Hamamcioglu MK (2009) Surgical complications of decompressive craniectomy for head trauma. Acta Neurochir (Wien). doi:10.1007/s00701-009-0476-1

    Google Scholar 

  87. Kilincer C, Simsek O, Hamamcioglu MK, Hicdonmez T, Cobanoglu S (2005) Contralateral subdural effusion after aneurysm surgery and decompressive craniectomy: case report and review of the literature. Clin Neurol Neurosurg 107:412–416

    Article  PubMed  Google Scholar 

  88. Meier U, Grawe A, Konig A (2005) The importance of major extracranial injuries by the decompressive craniectomy in severe head injuries. Acta Neurochir Suppl 95:55–57

    Article  PubMed  CAS  Google Scholar 

  89. Figaji AA, Fieggen AG, Argent AC, Le Roux PD, Peter JC (2008) Intracranial pressure and cerebral oxygenation changes after decompressive craniectomy in children with severe traumatic brain injury. Acta Neurochir Suppl 102:77–80

    Article  PubMed  CAS  Google Scholar 

  90. Bor-Seng-Shu E, Hirsch R, Teixeira MJ, De Andrade AF, Marino R Jr (2006) Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression. J Neurosurg 104:93–100

    Article  PubMed  Google Scholar 

  91. Sahuquillo JAF (2006) Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database of Systematic Reviews: Art. No.: CD003983. doi:003910.001002/14651858.CD14003983.pub14651852

  92. BW TA, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, Wallace D, Henning R, Tibballs J (2001) A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 3:154–162

    Google Scholar 

  93. Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell PM, Bousser MG, van der Worp HB, Hacke W (2007) Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6:215–222

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clarian Neuroscience, Goodman Campbell Brain and Spine, and Indiana University Department of Neurological Surgery, 1801 North Senate Blvd # 610, Indianapolis, IN, USA

    Ha Son Nguyen, James D. Callahan & Aaron A. Cohen-Gadol

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  1. Ha Son Nguyen
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  2. James D. Callahan
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  3. Aaron A. Cohen-Gadol
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Correspondence to Aaron A. Cohen-Gadol.

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Nguyen, H.S., Callahan, J.D. & Cohen-Gadol, A.A. Life-saving decompressive craniectomy for diffuse cerebral edema during an episode of new-onset diabetic ketoacidosis. Childs Nerv Syst 27, 657–664 (2011). https://doi.org/10.1007/s00381-010-1285-9

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