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58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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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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  • corresponding author D. Woischneck - Abteilung für Neuorchirurgie, Universitätsklinikum Ulm
  • A. Niedermeier - Abteilung für Neuorchirurgie, Universitätsklinikum Ulm
  • E. Rickels - Abteilung für Neuorchirurgie, Universitätsklinikum Ulm

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocP 058

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc313.shtml

Published: April 11, 2007

© 2007 Woischneck et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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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.