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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Decompressive surgery in children’s head trauma

Meeting Abstract

  • D. Woischneck - Klinik für Neurochirurgie, Universitätsklinikum Ulm
  • T. Kapapa - Klinik für Neurochirurgie, Universitätsklinikum Ulm
  • C. Grimm - Klinik für Neurochirurgie, Universitätsklinikum Ulm
  • R. Firsching - Klinik für Neurochirurgie, Universitätsklinikum Magdeburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.03-01

DOI: 10.3205/09dgnc010, URN: urn:nbn:de:0183-09dgnc0109

Published: May 20, 2009

© 2009 Woischneck et al.
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Outline

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Objective: Non-surgical therapy in children’s severe head trauma is challenging due to the lack of satisfying evidence-based data and difficult outcome. In life threatening intracranial hypertension decompressive craniectomy is a possible option. However, due to the small number of cases and absent randomisation questions about reduction of lethality and number of subjects in vegetative state remain. We state our findings.

Methods: Decompressive craniectomy was performed in 35 (mean age 12.8 years) children in a 4 years period. Surgery included craniotomy, subtemporal resection, opening of the dura and duroplasty. The Glasgow Outcome Score was assessed 6 months after surgery. Data of intensive care course and Glasgow Outcome Score were correlated (SPSS 13.0, SPSS Inc.)

Results: At the time of surgery unconsciousness had been present for a mean of 33 hours (min. 1.5h, max. 9 days). In 95% surgery was performed after additional disturbances in pupil function. In ten cases (50%) decompression was done on the non-dominant side, in 6 cases (30%) on the speech-dominant side. A bilateral decompression was done in 4 cases (20%). Fatality rate was 50% (10 children) after six months; one child was in a persistent vegetative state. Four children (20%) were severely or moderately disabled, respectively. One child (5%) had no impairments. 40% of the children with pre-operatively wide and fixed pupils survived. Two of these four children survived moderately disabled. All children with anisocorian status of pupils survived. The outcome does not correlate with the duration of coma. Survival without any or with mild impairments was possible, even in case of longer duration of coma. However, the duration of posttraumatic pupil disorders correlated negatively with outcome: the longer the pupil disorder, the worse the outcome (ANOVA, Fishers Exact Test, p=0.001).

Conclusions: This study supports the decrease of lethality due to decompressive craniectomy after severe head trauma. A disproportional increase of severely disabled children or children in a vegetative state could not be observed. Precondition of good outcome is fast indication in case of pupil disorders or abnormal extensions. Long coma duration or appearance of wide and fixed pupils does not constitute a contraindication for decompressive surgery.