gms | German Medical Science

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

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

The role of decompressive craniectomy in children with severe traumatic brain injury

Die Bedeutung der dekompressiven Kraniektomie bei Kindern mit schwerem Schädel-Hirn-Trauma

Meeting Abstract

  • corresponding author N. El Hindy - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • K.-P. Stein - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • O. Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • J.-P. Regel - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • D. Stolke - Klinik für Neurochirurgie, Universitätsklinikum Essen

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. DocFR.01.04

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc059.shtml

Veröffentlicht: 11. April 2007

© 2007 El Hindy et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: To evaluate the role of decompressive surgery in children with severe traumatic brain injury (TBI) refractory to conservative osmotic therapy.

Methods: A total of 35 children with severe head trauma were treated in our institution between 2001 and 2006. Of these, 27 underwent surgery for extraaxial mass lesion (acute epidural hematoma, acute subdural hematoma). The study focuses on the remaining 8 children with severe TBI, presenting with a Glascow Coma Scale (GCS)≤8 on admission and pathological findings in the CCT (diffuse axonal lesions, contusions or traumatic brain swelling). All children, except one, had continuous ICP-monitoring. Recordings of ICPs, duration of ventilation, secondary complications and outcome were evaluated.

Results: 4 children were treated conservatively only, with ICPs ranging below 25 mmHg under osmotic therapy. In 3 children, ICP levels raised markedly above 25 mmHg were refractory to intensified conservative management. The indication for decompressive craniectomy (DC) was set in all of them (2 bifrontal craniectomies, 1 hemicraniectomy). The interval between trauma and operation ranged from 72–96h. The remaining child underwent urgent surgery at admission due to brain swelling with impending tentorial herniation. Because of a delayed progression of the edema, decompression of the contralateral side was performed 7 days later. The overall treatment in the intensive care unit (ICU) was 25,5 days (range 12-58d). In children, who underwent DC, the stay in the ICU was longer (mean 28,75d), compared with those treated conservatively (mean 22,25d). Mean ventilation time was 18,25d (range 10-30d). In the DC group mean ventilation time was 20,7d and 15,75d for the group with osmotic therapy. Mean Glascow Outcome Score (GOS) at the time of discharge was 3 (range 2-4). The groups showed no difference regarding the GOS (in both groups the mean value was 3). There was no fatal outcome within the first 3 months. One child died 12 months later due to pneumonia.

Conclusions: Decompressive craniectomy is indicated in children with therapy refractory ICPs due to severe TBI. The outcome (GOS) for these children does not seem to be unfavorable when compared to those treated conservatively. We therefore recommend taking DC into early consideration for the treatment of refractory elevated ICPs in children.