Artikel
Decompressive craniectomy for traumatic brain injury in children and adolescents
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Traumatic brain injury (TBI) is the leading cause of death and severe disability in children and adolescents. Decompressive craniectomy may lower intracranial pressure, but its value for the outcome still remains unclear. Only one randomized trial in the pediatric population demonstrates benefits on the outcome for the decompressive craniectomy group. We add a systematic analysis of a decompressive craniectomy case series in our pediatric traumatic brain injury cohort to the sparse reports in the literature.
Method: We performed a retrospective single center study over an eleven year period (2004 - 2014) at the university clinic of St. Pölten, Austria. All children and adolescents up to 18 years of age, who were admitted to the hospital for traumatic brain injury were screened. The mean follow-up period in the surviving patients was 6,9 years, ranging from 0,7 to 10 years.
Results: 1994 children and adolescents were admitted to our hospital following a traumatic brain injury. In 3% (54/1994) of these patients, we performed one form of a neurosurgical procedure. 22% (12/54) of this cohort underwent either unilateral or bilateral decompressive craniectomy. 92% (11/12) had a severe-, whereas only one patient had a mild traumatic brain injury, respectively. Mortality was 42% (5/12) and two patients (17%) remained in a permanent vegetative state. 42% (5/12) of the patients had a good outcome of 4 or 5 according to the Glasgow Outcome Score.
Conclusions: The incidence of neurosurgical procedures in pediatric and adolescent traumatic brain injuries is low. Prediction of neurologic outcome in surgically treated severe traumatic brain injury in young human beings is difficult. Mortality and morbidity in severe traumatic brain injury treated with decompressive craniectomy is rather high. However, more than one third of our patient cohort had a good outcome. The predictive value of neurologic outcome with decompressive craniectomy for traumatic brain injury in the pediatric population still remains unclear.