gms | German Medical Science

Objective: Contrary to the adult population, where high-level evidence-based treatment options analysed by recent trials such as STITCH make an impact on daily routine, the surgical treatment of the traumatic brain injury (TBI) in the pediatric population, especially the usage of decompressive craniectomy (DC) remains a controversial theme, despite TBI being one of the most frequent neurological presentations in emergency departments worldwide and leading not only to early but also to late damage. Here we tried to clarify the effect of DC in pediatric TBI.

Methods: A systematic search was done in MEDLINE and Web of Knowledge databases for publications regarding the surgical treatment of TBI in pediatric population with DC, with the keywords “trauma”, and “pediatric” or “children” along with any combinations of the words “decompression”, “decompressive” or “craniectomy”. The list was supplemented by reviewing the bibliographies of selected papers. Individual case reports as well as studies not providing quantitative data were excluded. In the end 15 retrospective case series were analysed in addition to a single randomized study. Obtained data included demographics, clinic at presentation, treatment protocols and outcome.

Results: 194 patients underwent DC. The underlying pathologies varied greatly but were dominated by multiple injuries (42 patients). In some case series the diagnose was reported only as TBI (67 patients) or only the diagnoses seen in the collective was referred, without giving further details (54 patients). Although the preoperative median Glasgow Coma Scale lay between 3 and 7, a favourable outcome was reported on 123 patients. Complications were heterogenous but dominated by hydrocephalus, hygroma and meningitis. Due to the heterogeneity and small size of the studies individual factors influencing the outcome could not be determined.

Conclusion: Present data suggests that DC has a possible beneficial role in the treatment of TBI in pediatric population, however the quality of evidence prevents drawing conclusions. Further studies in randomized – controlled settings are needed to establish clear roadmaps.