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

Combined infratentorial and supratentorial decompressive craniectomy after pediatric brain injury

Kombiniert supra- und infratentorielle, dekompressive Kraniektomie beim kindlichen Schädel-Hirn-Trauma

Meeting Abstract

  • 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:

Published: April 11, 2007

© 2007 Woischneck et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.