J Pediatr Intensive Care 2018; 07(01): 033-038
DOI: 10.1055/s-0037-1603825
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Rescue Decompressive Craniectomy in Children with Severe Traumatic Brain Injury

Dimitrios Rallis
1   Pediatric Intensive Care Unit, “Aghia Sophia” Children's Hospital, Athens, Greece
,
Panagiotis Poulos
1   Pediatric Intensive Care Unit, “Aghia Sophia” Children's Hospital, Athens, Greece
,
Maria Kazantzi
1   Pediatric Intensive Care Unit, “Aghia Sophia” Children's Hospital, Athens, Greece
,
Panagiotis Kalampalikis
1   Pediatric Intensive Care Unit, “Aghia Sophia” Children's Hospital, Athens, Greece
› Author Affiliations
Further Information

Publication History

15 March 2017

10 May 2017

Publication Date:
19 June 2017 (online)

Abstract

Decompressive craniectomy (DC) is considered a rescue therapy in patients with traumatic brain injury (TBI) with increased intracranial pressure (ICP). In this retrospective study, we examined the impact of craniectomy on ICP in children with severe TBI and their neurological outcome. A total of 14 patients were enrolled. Peak ICP was significantly lower (31 ± 2.9 to 19 ± 4.6, p < 0.001) and minimum cerebral perfusion pressure (CPP) higher (41 ± 10.5 to 58 ± 11.4, p < 0.001) postcraniectomy. The survival rate was 71%. However, 57% of our cohort had a poor neurological outcome at 6 months postinjury. In conclusion, although rescue DC was effective in controlling ICP and CPP, the long-term neurological outcome remained poor.

 
  • References

  • 1 Corrigan JD, Selassie AW, Orman JA. The epidemiology of traumatic brain injury. J Head Trauma Rehabil 2010; 25 (02) 72-80
  • 2 Karamanos E, Teixeira PG, Sivrikoz E. , et al. Intracranial pressure versus cerebral perfusion pressure as a marker of outcomes in severe head injury: a prospective evaluation. Am J Surg 2014; 208 (03) 363-371
  • 3 Jagannathan J, Okonkwo DO, Dumont AS. , et al. Outcome following decompressive craniectomy in children with severe traumatic brain injury: a 10-year single-center experience with long-term follow up. J Neurosurg 2007; 106 (4, Suppl): 268-275
  • 4 Rutigliano D, Egnor MR, Priebe CJ. , et al. Decompressive craniectomy in pediatric patients with traumatic brain injury with intractable elevated intracranial pressure. J Pediatr Surg 2006; 41 (01) 83-87 , discussion 83–87
  • 5 Taylor A, Butt W, Rosenfeld J. , et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 2001; 17 (03) 154-162
  • 6 Gooch MR, Gin GE, Kenning TJ, German JW. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 2009; 26 (06) E9 . Doi: 10.3171/2009.3.FOCUS0962
  • 7 Honeybul S, Ho KM. Long-term complications of decompressive craniectomy for head injury. J Neurotrauma 2011; 28 (06) 929-935
  • 8 Kochanek PM, Carney N, Adelson PD. , et al; American Academy of Pediatrics-Section on Neurological Surgery; American Association of Neurological Surgeons/Congress of Neurological Surgeons; Child Neurology Society; European Society of Pediatric and Neonatal Intensive Care; Neurocritical Care Society; Pediatric Neurocritical Care Research Group; Society of Critical Care Medicine; Paediatric Intensive Care Society UK; Society for Neuroscience in Anesthesiology and Critical Care; World Federation of Pediatric Intensive and Critical Care Societies. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med 2012; 13 (Suppl. 01) S1-S82
  • 9 Qureshi AI, Suarez JI. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med 2000; 28 (09) 3301-3313
  • 10 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 24 (05) 743-752
  • 11 Baker SP, O'Neill B, Haddon Jr W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14 (03) 187-196
  • 12 Liesemer K, Riva-Cambrin J, Bennett KS. , et al. Use of Rotterdam CT scores for mortality risk stratification in children with traumatic brain injury. Pediatr Crit Care Med 2014; 15 (06) 554-562
  • 13 Pechmann A, Anastasopoulos C, Korinthenberg R, van Velthoven-Wurster V, Kirschner J. Decompressive craniectomy after severe traumatic brain injury in children: complications and outcome. Neuropediatrics 2015; 46 (01) 5-12
  • 14 Beers SR, Wisniewski SR, Garcia-Filion P. , et al. Validity of a pediatric version of the Glasgow Outcome Scale-Extended. J Neurotrauma 2012; 29 (06) 1126-1139
  • 15 Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 2006; 104 (04) 469-479
  • 16 Hejazi N, Witzmann A, Fae P. Unilateral decompressive craniectomy for children with severe brain injury. Report of seven cases and review of the relevant literature. Eur J Pediatr 2002; 161 (02) 99-104
  • 17 Ho CL, Wang CM, Lee KK, Ng I, Ang BT. Cerebral oxygenation, vascular reactivity, and neurochemistry following decompressive craniectomy for severe traumatic brain injury. J Neurosurg 2008; 108 (05) 943-949
  • 18 Polin RS, Shaffrey ME, Bogaev CA. , et al. Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 1997; 41 (01) 84-92 , discussion 92–94
  • 19 Whitfield PC, Patel H, Hutchinson PJ. , et al. Bifrontal decompressive craniectomy in the management of posttraumatic intracranial hypertension. Br J Neurosurg 2001; 15 (06) 500-507
  • 20 Grille P, Tommasino N. Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications. Rev Bras Ter Intensiva 2015; 27 (02) 113-118
  • 21 Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien) 2006; 148 (03) 255-268 , discussion 268
  • 22 Cooper DJ, Rosenfeld JV, Murray L. , et al; DECRA Trial Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364 (16) 1493-1502
  • 23 Hutchinson PJ, Kolias AG, Timofeev IS. , et al; RESCUEicp Trial Collaborators. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med 2016; 375 (12) 1119-1130
  • 24 Belli A, Sen J, Petzold A, Russo S, Kitchen N, Smith M. Metabolic failure precedes intracranial pressure rises in traumatic brain injury: a microdialysis study. Acta Neurochir (Wien) 2008; 150 (05) 461-469 , discussion 470
  • 25 Li M, Chen T, Chen SD, Cai J, Hu YH. Comparison of equimolar doses of mannitol and hypertonic saline for the treatment of elevated intracranial pressure after traumatic brain injury: a systematic review and meta-analysis. Medicine (Baltimore) 2015; 94 (17) e736 . Doi: 10.1097/MD.0000000000000736
  • 26 Anderson RC, Kan P, Klimo P, Brockmeyer DL, Walker ML, Kestle JR. Complications of intracranial pressure monitoring in children with head trauma. J Neurosurg 2004; 101 (1, Suppl): 53-58
  • 27 Figaji AA, Fieggen AG, Peter JC. Early decompressive craniotomy in children with severe traumatic brain injury. Childs Nerv Syst 2003; 19 (09) 666-673
  • 28 Josan VA, Sgouros S. Early decompressive craniectomy may be effective in the treatment of refractory intracranial hypertension after traumatic brain injury. Childs Nerv Syst 2006; 22 (10) 1268-1274
  • 29 Mhanna MJ, Mallah WE, Verrees M, Shah R, Super DM. Outcome of children with severe traumatic brain injury who are treated with decompressive craniectomy. J Neurosurg Pediatr 2015; 16 (05) 508-514
  • 30 Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev 2006; (01) CD003983
  • 31 Kan P, Amini A, Hansen K. , et al. Outcomes after decompressive craniectomy for severe traumatic brain injury in children. J Neurosurg 2006; 105 (5, Suppl): 337-342
  • 32 Skoglund TS, Eriksson-Ritzén C, Jensen C, Rydenhag B. Aspects on decompressive craniectomy in patients with traumatic head injuries. J Neurotrauma 2006; 23 (10) 1502-1509
  • 33 Carney N, Totten AM, O'Reilly C. , et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 2017; 80 (01) 6-15
  • 34 Alvis-Miranda H, Castellar-Leones SM, Moscote-Salazar LR. Decompressive craniectomy and traumatic brain injury: a review. Bull Emerg Trauma 2013; 1 (02) 60-68
  • 35 Piedra MP, Ragel BT, Dogan A, Coppa ND, Delashaw JB. Timing of cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke. J Neurosurg 2013; 118 (01) 109-114
  • 36 Frassanito P, Massimi L, Caldarelli M, Tamburrini G, Di Rocco C. Complications of delayed cranial repair after decompressive craniectomy in children less than 1 year old. Acta Neurochir (Wien) 2012; 154 (05) 927-933
  • 37 Chang V, Hartzfeld P, Langlois M, Mahmood A, Seyfried D. Outcomes of cranial repair after craniectomy. J Neurosurg 2010; 112 (05) 1120-1124
  • 38 Yadla S, Campbell PG, Chitale R, Maltenfort MG, Jabbour P, Sharan AD. Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review. Neurosurgery 2011; 68 (04) 1124-1129 , discussion 1130
  • 39 Rocque BG, Amancherla K, Lew SM, Lam S. Outcomes of cranioplasty following decompressive craniectomy in the pediatric population. J Neurosurg Pediatr 2013; 12 (02) 120-125
  • 40 Grant GA, Jolley M, Ellenbogen RG, Roberts TS, Gruss JR, Loeser JD. Failure of autologous bone-assisted cranioplasty following decompressive craniectomy in children and adolescents. J Neurosurg 2004; 100 (2, Suppl Pediatrics): 163-168