Decompressive craniectomy in pediatric patients with traumatic brain injury with intractable elevated intracranial pressure

Rutigliano, Daniel N.; Egnor, Michael; Priebe, Cedric J.; McCormack, Jane E.; Strong, Nancy; Scriven, Richard J.; Lee, Thomas K.

doi:10.1016/j.jpedsurg.2005.10.010

Cited by 78 publications

(53 citation statements)

References 25 publications

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“…Several studies have shown a favorable outcome after DC in children with severe TBI. 6,7,11,[18][19][20][21]23 However, others have shown a poor outcome after DC in children with severe TBI, when DC was done for increased ICP only, 13 and in adults with severe TBI and refractory raised ICP. 3 Polin et al, in a case-control study of adults and pediatric patients, have shown a favorable outcome in patients who underwent craniotomies, with a mortality rate of 23% (8/35), 18 which is similar to our mortality rate of , and CVPs (c) in the DC and control groups.…”

Section: Discussionmentioning

confidence: 99%

“…19 Rutigliano et al, in another series of 6 patients with TBI and treated with DC, found that 5 patients left the hospital either independently or with some form of minimal assistance. 20 Taylor et al, in a randomized trial of very early DC in children with TBI and sustained intracranial hypertension, reported that 54% (7/13) of their patients who underwent a DC survived with a favorable outcome, in comparison with 14% (2/14) in the control group. 23 Their findings are similar to ours; 42% of our patients who had a DC and survived had a favorable outcome, in comparison with none of the patients who were in the control group.…”

Section: % (5/17mentioning

confidence: 99%

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Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Mhanna

Mallah

Verrees³

et al. 2015

PED

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OBJECT Decompressive craniectomy (DC) for the management of severe traumatic brain injury (TBI) is controversial. The authors sought to determine if DC improves the outcome of children with severe TBI. METHODS In a retrospective, case-control study, medical records of all patients admitted to the pediatric ICU between May 1998 and May 2008 with severe TBI and treated with DC were identified and matched to patients who were treated medically without DC. Medical records were reviewed for patients’ demographic data and baseline characteristics. RESULTS During the study period, 17 patients with severe TBI treated with DC at a median of 2 hours (interquartile range [IQR] 1–14 hours) after admission were identified and matched to 17 contemporary controls. On admission, there were no differences between DC and control patients regarding age (10.2 ± 5.9 years vs 12.4 ± 5.4 years, respectively [mean ± SD]), sex, weight, Glasgow Coma Scale score (median 5 [IQR 3–7] vs 4 [IQR 3–6], respectively; p = 0.14), or the highest intracranial pressure (median 42 [IQR 22–54] vs 30 [IQR 21–36], respectively; p = 0.77). However, CT findings were significant for a higher rate of herniation and cerebral edema among patients with DC versus controls (7/17 vs 2/17, respectively, had herniation [p = 0.05] and 14/17 vs 6/17, respectively, had cerebral edema [p = 0.006]). Overall there were no significant differences in survival between patients with DC and controls (71% [12/17] vs 82% [14/17], respectively; p = 0.34). However, among survivors, at 4 years (IQR 1–6 years) after the TBI, 42% (5/12) of the DC patients had mild disability or a Glasgow Outcome Scale score of 5 vs none (0/14) of the controls (p = 0.012). CONCLUSIONS In this retrospective, small case-control study, the authors have shown that early DC in pediatric patients with severe TBI improves outcome in survivors. Future prospective randomized controlled studies are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Section: % (5/17mentioning

confidence: 99%

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Mhanna

Mallah

Verrees³

et al. 2015

PED

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“…Rutigliano et al 13 presented data on 30 patients with a mean GCS score of 8, and ranging in age from 3 to 13 years. Six patients with ICP > 20 cm H 2 O for 1-6 hours required decompressive craniectomy.…”

Section: Discussionmentioning

confidence: 99%

Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries

Adamo

Drazin

Waldman

2009

PED

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Object Infants with severe traumatic brain injury represent a therapeutic challenge. The internal absence of open space within the infant cranial vault makes volume increases poorly tolerated. This report presents 7 cases of decompressive craniectomy in infants with cerebral edema. Methods The authors reviewed the medical charts of infants with brain injuries who presented to Albany Medical Center Hospital between January 2004 and July 2007. Variables that were examined included patient age, physical examination results at admission, positive imaging findings, surgery performed, complications, requirement of permanent CSF diversion, and physical examination results at discharge and outpatient follow-up using the King's Outcome Scale for Childhood Head Injury. Seven infants met the inclusion criteria for the study. Six infants experienced nonaccidental trauma, and 1 had a large infarction of the middle cerebral artery territory secondary to a carotid dissection. At admission, all patients were minimally responsive, 4 had equal and minimally reactive pupils, 3 had anisocoria with the enlarged pupil on the same side as the brain lesion, and all had right-sided hemiparesis. Six patients received a left hemicraniectomy, whereas 1 received a left frontal craniectomy. In all cases, bone was cultured and stored at the bone bank. Results Postoperatively, 3 patients who developed draining CSF fistulas needed insertions of external ventricular drains, with incisions oversewn using nylon sutures and a liquid bonding agent. After prolonged CSF drainage and wound care, these patients all developed epidural and subdural empyemas necessitating surgical drainage and debridement. Methicillin-resistant Staphylococcus aureus was found in 2 patients and Enterococcus in the third. All patients developed hydrocephalus necessitating the insertion of a ventriculoperitoneal shunt, and all had bone replaced within 1–6 months from the time of the original operation. Two patients required reoperation due to bone resorption. At outpatient follow-up visits, all had scores of 3 or 4 on the King's Outcome Scale for Childhood Head Injury. Each patient was awake, interactive, and could sit, as well as either crawl or walk with assistance. All had persistent, improving right-sided hemiparesis and spasticity. Conclusions Despite poor initial examination results, infants with severe traumatic brain injury can safely undergo decompressive craniectomy with reasonable neurological recovery. Postoperative complications must be anticipated and treated appropriately. Due to the high rate of CSF fistulas encountered in this study, it appears reasonable to recommend both the suturing in of a dural augmentation graft and the placement of either a subdural drain or a ventriculostomy catheter to relieve pressure on the healing surgical incision. Also, one might want to consider using a T-shaped incision as opposed to the traditional reverse question mark-shaped incision because wound healing may be compromised due to the potential interruption of the circulation to the posterior and inferior limb with this latter incision.

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“…The mean years of patient accrual were between 1989 and 2006 [6,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]. When combining these cases with our cohort, the total sample rose to 193 children.…”

Section: Resultsmentioning

confidence: 99%

Decompressive Hemicraniectomy for Pediatric Traumatic Brain Injury: Long-Term Outcome Based on Quality of Life

et al. 2011

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Aims: The impact of decompressive hemicraniectomy (DCH) on the overall outcome of pediatric brain injury patients has not been fully determined. In this paper, the authors performed a systematic review of patient outcome based on quality of life following DCH in a pediatric population. Methods: We describe our experience with decompressive craniectomy in pediatric patients and perform a literature review and pooled outcomes analysis to supplement these findings. A total of 13 children underwent DCH for intractable intracranial pressure in our institution from 2000 to 2008. Follow-up was available in 11 patients with 1 death (9%) and 7 survivors (70%) obtaining a favorable outcome (Glasgow Outcome Scale, GOS, scores = 4–5). Results: A literature review to determine the usefulness of DCH identified 17 articles that, when combined with our series, resulted in 186 pediatric DCH cases. Pooled outcomes found 42 deaths and 112 patients who had favorable outcomes at 6 months. The average 6-month mortality was 21.1%, and the pooled mean quality of life among survivors 0.75 (0.68–0.82), midway between moderate disability and good outcome. Conclusions: Based on our findings, DCH results in a majority of pediatric patients having a good outcome based on the GOS score.

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Decompressive craniectomy in pediatric patients with traumatic brain injury with intractable elevated intracranial pressure

Cited by 78 publications

References 25 publications

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy

Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries

Decompressive Hemicraniectomy for Pediatric Traumatic Brain Injury: Long-Term Outcome Based on Quality of Life

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