Artikel
Combined infratentorial and supratentorial decompressive craniectomy after pediatric brain injury
Kombiniert supra- und infratentorielle, dekompressive Kraniektomie beim kindlichen Schädel-Hirn-Trauma
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Veröffentlicht: | 11. April 2007 |
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Objective: Supratentorial craniectomy is an acknowledged procedure to save the life of children with malignant intracranial hypertension after brain injury (BI). Unsuccessful intervention can be explained by additional infratentorial herniation.
Methods: A 9-year-old female was admitted comatose after brain injury. Cerebral computerized tomography (CT) by admission revealed a supratentorial swelling, intracranial pressure (ICP) ranged below 25 mmHg for 6 days. MRI revealed a lesion of the dorsal pons adjacent to the swollen cerebellum. On day 6 after BI, the coma grade decreased rapidly expired in bilaterally fixed pupils. CT revealed an additional infratentorial swelling, ICP decompensated. A bilateral craniectomy and additionally a suboccipital decompression were performed. In all 3 cavities, the dura was operatively enlarged.
Results: The child emerged from coma 2 days after the operation. The patient was severely disabled 6 month after surgery. Follow-up MRI revealed a sclerosis of the tegmentum pontis and an isolated IV ventricle.
Conclusions: In despairing cases, a combined decompressive craniectomy of all 3 cranial cavities is justified.