Decompressive Craniectomy for Traumatic Intracranial Hypertension in Children

Semenova, Zhanna B.; Meshcheryakov, S. V.; Lukyanov, V. I.; Arsenyev, Sergey

doi:10.1007/978-3-030-59436-7_23

Cited by 7 publications

(2 citation statements)

References 15 publications

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“…DC is an effective procedure to alleviate extremely high ICP, although the evidence of efficacy amongst different neurological pathologies is variable [25,26]. For most diseases, an ICP threshold of 19 mmHg has been associated with good outcome; nevertheless, lower ICP values may improve survival [27].…”

Section: Discussionmentioning

confidence: 99%

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

et al. 2021

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Background: Morphological alterations in intracranial pressure (ICP) pulse waveform (ICPW) secondary to intracranial hypertension (ICP >20 mmHg) and a reduction in intracranial compliance (ICC) are well known indicators of neurological severity. The exclusive exploration of modifications in ICPW after either the loss of skull integrity or surgical procedures for intracranial hypertension resolution is not a common approach studied. The present study aimed to assess the morphological alterations in ICPW among neurocritical care patients with skull defects and decompressive craniectomy (DC) by comparing the variations in ICPW features according to elevations in mean ICP values. Methods: Patients requiring ICP monitoring because of acute brain injury were included. A continuous record of 10 min-length for the beat-by-beat analysis of ICPW was performed, with ICP elevation produced by means of ultrasound-guided manual internal jugular vein compression at the end of the record. ICPW features (peak amplitude ratio (P2/P1), time interval to pulse peak (TTP) and pulse amplitude) were counterweighed between baseline and compression periods. Results were distributed for three groups: intact skull (exclusive burr hole for ICP monitoring), craniotomy/large fractures (group 2) or DC (group 3). Results: 57 patients were analyzed. A total of 21 (36%) presented no skull defects, 21 (36%) belonged to group 2, whereas 15 (26%) had DC. ICP was not significantly different between groups: ±15.11 for intact, 15.33 for group 2 and ±20.81 mmHg for group 3, with ICP-induced elevation also similar between groups (p = 0.56). Significant elevation was observed for the P2/P1 ratio for groups 1 and 2, whereas a reduction was observed in group 3 (elevation of ±0.09 for groups 1 and 2, but a reduction of 0.03 for group 3, p = 0.01), and no significant results were obtained for TTP and pulse amplitudes. Conclusion: In the present study, intracranial pressure pulse waveform analysis indicated that intracranial compliance was significantly more impaired among decompressive craniectomy patients, although ICPW indicated DC to be protective for further influences of ICP elevations over the brain. The analysis of ICPW seems to be an alternative to real-time ICC assessment.

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Section: Discussionmentioning

confidence: 99%

Intracranial Compliance Assessed by Intracranial Pressure Pulse Waveform

et al. 2021

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“…Decompressive craniectomy (DC) has been performed rarely in the pediatric population (0.1% of all hospitalized pTBI from 2014 to 2018) [ 8 ]. However, after 2018, recent studies have shown a beneficial effect on the neurological outcome for some selected patients with pTBI [ 29 , 30 ]. Despite updated guidelines, the role of DC remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Incidence of acute neurosurgery for traumatic brain injury in children—a nationwide analysis from 1998 to 2018

et al. 2023

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Background Most of moderate and severe pTBIs are managed conservatively, but in some cases neurosurgical interventions are needed. The incidence rates of acute pTBI neurosurgery vary considerably between countries and operation types. Our goal was to assess the incidence of acute pTBI neurosurgery in Finland. Methods We conducted a retrospective Finnish register-based cohort study from 1998 to 2018. We included all patients that were 0 to 17 years of age at the time of the TBI. The incidence rates of patients with pTBI undergoing neurosurgery and the rates for specific operation types were calculated per 100,000 person-years. We compared the annual incidences with incidence rate ratios (IRR) with 95% confidence intervals (CI). We stratified patients to three age categories: (i) 0 to 3 years of age, (ii) 4 to 12 years of age, and (iii) 13 to 17 years of age. Results The total number of neurosurgeries for acute pTBI during the study period was 386, and the cumulative incidence was 1.67 operations per 100,000 person-years. The cumulative incidence during the 21-year follow-up was highest at the age of 16 (IRR 4.78, CI 3.68 to 6.11). Boys had a 2.42-time higher cumulative incidence (IRR 2.35, CI 1.27 to 3.99) than girls (IRR 0.97, CI 0.35 to 2.20). The most common neurosurgery was an evacuation of an intracranial hemorrhage (n = 171; 44.3%). Conclusion The incidence of neurosurgeries for pTBIs has been stable from 1998 to 2018. The incidence was highest at the age of 16, and boys had higher incidence than girls.

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