Artikel
Some considerations of decompressive craniectomy for severe traumatic brain injury ofinfants
Einige Überlegungen der dekomprimierenden Kraniektomie für schwere traumatische Hirnverletzungen von Säuglingen
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Autoren
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Taekyun Kim
- Nara Medical University, Neurosurgery, Kashihara, Japan
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Young-Soo Park
- Nara Medical University, Neurosurgery, Kashihara, Japan
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Yasushi Motoyama
- Nara Medical University, Neurosurgery, Kashihara, Japan
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Hiroyuki Nakase
- Nara Medical University, Neurosurgery, Kashihara, Japan
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Brain edema after severe traumatic brain injury (sTBI) is a common occurrence in infants resulting in elevated intracranial pressure (ICP), and causing a severe or fatal state. Because of infant brain plasticity, however, appropriate treatments to improve ICP can lead to positive outcomes. Decompressive craniectomy (DC) is an effective strategy in adults for cases of high ICP that are refractory to medication, but it is important to specify the treatment for the unique complications in infants, such as bone resorption and infections. To avoid such complications, we have taken some intraoperative steps and strictly controlled the ICP in the postoperative phase for a better outcome.
Methods: From January 2013 to December 2017, four patients with sTBI underwent DC and hypothermia barbiturate (HB) therapy. The mean ageof the patients was 9.75 months (range, 2–20 months) and the mean follow-up period was 26 months (range, 12–50.5 months). We retrospectively reviewed information regarding bone resorption, ICP movements, HB therapy complications and clinical outcomes of the four patients. DC was conducted under the following rules:
- 1.
- do not remove the bone flap unless its infected,
- 2.
- make a vascularized bone flap with a hinge using the temporal muscle,
- 3.
- do not use an artificial material, but an autologous fascia or periosteum instead for duroplasty,
- 4.
- place the bone flap "floating" on the brain, do not fix it to the cranial bone,
- 5.
- attach absorbable cranial fix plates only to the bone flap to prevent sinking, and
- 6.
- strictly control ICP in the Intensive Care Unit by HB therapy.
Results: All four patients survived with sufficient lowering of ICP following complete DC and HB therapy. None of the patients exhibited bone resorption or other severe complications. Two patients recovered well, while two patients, who experienced child abuse, were severely disabled (SD).
Conclusion: Appropriate treatment can change the outcome of an infant with sTBI. Our DC technique was effective in decreasing ICP and avoiding severe complications. Bone formation was adequate so that subsequent cranioplasty was not necessary.
