gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

The role of decompressive craniectomy in children with severe traumatic brain injury

Meeting Abstract

  • Nicolai El-Hindy - Abteilung für Neurochirurgie, Universitätsklinik Essen, Essen, Deutschland
  • Klaus Peter Stein - Abteilung für Neurochirurgie, Universitätsklinik Essen, Essen, Deutschland
  • Vincent Hagel - Abteilung für Neurochirurgie, Universitätsklinik Essen, Essen, Deutschland
  • Philipp Dammann - Abteilung für Neurochirurgie, Universitätsklinik Essen, Essen, Deutschland
  • Ulrich Sure - Abteilung für Neurochirurgie, Universitätsklinik Essen, Essen, Deutschland
  • Oliver Müller - Abteilung für Neurochirurgie, Universitätsklinik Essen, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.14.02

doi: 10.3205/13dgnc396, urn:nbn:de:0183-13dgnc3968

Published: May 21, 2013

© 2013 El-Hindy et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Severe traumatic brain injury remains the leading cause of death in children. The present study analyses the outcome of children after severe traumatic brain injury (TBI) treated by decompressive craniectomy (DC) due to elevated intracranial pressure (ICP) in a single centre.

Method: 56 consecutive children (age <16 years) were treated for their severe TBI at our institution between 2001 and 2012. For study purposes children with severe generalized traumatic brain swelling without concomitant mass lesion were further analysed. Descriptive statistics were used to report clinical conditions (GCS, concomitant injuries, pupil reaction, cranial CT scan, ICP) as well as outcome measurements (GOS) after conservative treatment only in comparison to secondary decompressive craniectomy.

Results: Of 56 children a total of nine children presented with generalized and progressive traumatic brain swelling and impending brain herniation. 4 children were treated conservatively following standardized local protocol for anti-oedematous management, with ICP amenable to intensified therapy. Five children required decompressive surgery due to progressive oedema refractory to intensified conservative management. Children receiving secondary DC had a longer stay on the intensive care unit (ICU; mean 28.8 days) as well as a longer average time of assisted ventilation (20.0 days), compared to children treated conservatively (mean stay on ICU of 22.25 days and ventilation time of 15.75 days). Concomitant injuries were more severe in the DC subgroup. Yet, GOS was equally distributed in both groups (4) at three-month follow-up. There was no fatal outcome within the first 3 months.

Conclusions: In children with refractory ICP conditions due to severe TBI decompressive surgery might lead to a similar favourable outcome compared to children in whom ICP can be controlled only by conservative management. Timing of surgery depends decisive on the neurological deterioration of the patients and a continuous ICP monitoring.