The importance of very early decompressive craniectomy as a prevention to avoid the sudden increase of intracranial pressure in children with severe traumatic brain swelling (retrospective case series)

Abstract

Considering the anamnestic data, it could be useful to perform DC at 20-22 mmHg ICP in young patients in order to prevent the potential of very fast brain swelling if there is no possibility to perform durotomy within 20 min after the onset of raising the ICP. It is especially considerable in poor countries where the emergency route could be less organized because of locations of building and extreme load of the staff. Further controlled trials are necessary to evaluate the indication and standardization of early decompressive craniectomy as a standard preventive therapy in pediatric severe traumatic brain swelling.

Surgical results of decompressive craniectomy in very young children: A level one trauma centre experience from India

“…A number of studies have documented the role of DC in TBI in adults, but very few studies can be found in relation to paediatric age group [3,5,6,[11][12][13][14][15]. Similarly, reports both for [3,8,13] and against DC [6,28,29] can be found in the literature.…”

“…Different types of DC have been described in the literature, which includes bifrontal, bitemporal, wide unilateral and bilateral hemicraniectomies with/without duraplasty, among others [3,13,15]. Diffuse cerebral oedema (DCE) is one specific entity which occurs much more commonly in children and can lead to a profound rise in intracranial hypertension if not treated early.…”

“…In a small retrospective series, Csokay et al [15] included eight children with a mean age of 5.9 years. Best medical treatment was continued in cases of ICP420 mm Hg and considered DC only in cases of persistent raised ICP425 mm Hg.…”

“…Also, the timing of DC is controversial [5]. Although a number of studies quoting the role of decompressive craniectomy in adults have been reported [5][6][7][8][9], literature is sparse regarding the role of DC in TBI for paediatric patients and more so for very young children [3,[10][11][12][13][14][15]. The purpose of this study was to quote our tertiary care institutional experience in dealing with such young children and highlight the timing, effectiveness and complications associated with surgical decompression.…”

Bifrontal Biparietal Cruciate Decompressive Craniectomy in Pediatric Traumatic Brain Injury

“…However, some studies suggest early DC may improve outcomes in pediatric severe TBI [10-12]. Several surgical techniques have been used in previous studies, such as unilateral DC and bifrontal DC.…”