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56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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Decompressive craniectomy in children for severe traumatic brain injury

Dekompressive Kraniektomie bei Kindern mit schwerem SHT

Meeting Abstract

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  • corresponding author M. J. Fritsch - Departments of Neurosurgery and Pediatrics, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • M. Padoin - Departments of Neurosurgery and Pediatrics, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • L. Dörner - Departments of Neurosurgery and Pediatrics, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • M. F. Krause - Departments of Neurosurgery and Pediatrics, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • H. M. Mehdorn - Departments of Neurosurgery and Pediatrics, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-14.03

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0067.shtml

Published: May 4, 2005

© 2005 Fritsch 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.

Outline

Text

Objective

Severe traumatic brain injury in children has significant morbidity and mortality. Decompressive craniectomy is one of the “last option” treatments for therapy resistant increased intracranial pressure.

Methods

We retrospectively evaluated 15 pediatric patients (10 male, 5 female) who had undergone decompressive craniectomy following severe TBI. The mean age at the time of surgery was 9 years (7 months – 17 years). The average GCS at admission was 5 (3 – 9). Three patients were transferred from outside hospitals after decompensation. All three patients died, despite craniectomy. Eight patients were operated unilaterally and 7 patients bilaterally. ICP and cerebral perfusion pressure (CPP) were evaluated before and after the decompressive surgery. In all patients a wide hemispheric craniectomy with dura-plasty was performed.

Results

Average ICP prior to decompression was 38 mm Hg and average CPP prior to decompression was 54 mm Hg. Following the procedure the average ICP was 13 mm Hg and the average CPP was 73 mm Hg. The GOS at 6 and 12 months post surgery was 2, ranging from 1 to 4. There was no difference in GOS at 6 or 12 months.

Conclusions

Pediatric patients with severe traumatic brain injury should be admitted early to a neurotrauma center. Early monitoring (ICP, CPP, and ptiO2) should be performed. The decision to decompress should be based on monitoring trends, rather than only on absolute numbers. In our experience a wide decompression with dura-plasty is the only procedure of choice.