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Neuropediatrics 2015; 46(01): 005-012
DOI: 10.1055/s-0034-1393707
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Decompressive Craniectomy after Severe Traumatic Brain Injury in Children: Complications and Outcome

Astrid Pechmann
1   Division of Neuropediatrics and Muscle Disorders, University Medical Center Freiburg, Freiburg, Germany
,
Constantin Anastasopoulos
1   Division of Neuropediatrics and Muscle Disorders, University Medical Center Freiburg, Freiburg, Germany
,
Rudolf Korinthenberg
1   Division of Neuropediatrics and Muscle Disorders, University Medical Center Freiburg, Freiburg, Germany
,
Vera van Velthoven-Wurster
2   Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
,
Janbernd Kirschner
1   Division of Neuropediatrics and Muscle Disorders, University Medical Center Freiburg, Freiburg, Germany
› Author Affiliations
Further Information

Publication History

10 April 2014

15 July 2014

Publication Date:
24 October 2014 (online)

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The Underestimated Complication Rate of Decompressive Craniectomy in Pediatric Traumatic Brain InjuryNeuropediatrics 2015; 46(01): 003-004
DOI: 10.1055/s-0034-1389899

Abstract

Decompressive craniectomy (DC) is a controversially discussed neurosurgical procedure to reduce elevated intracranial pressure after severe traumatic brain injury (TBI). In contrast to adults, several studies could show a benefit for the pediatric population, but still DC is considered as an emergency procedure only. The aim of our study was to identify secondary complications and long-term sequelae of the procedure. All children presenting to the University Medical Center Freiburg between 2005 and 2013 who underwent DC after severe TBI were retrospectively reviewed with respect to complications and outcome. Twelve children were included with a mean Glasgow Coma Scale of 4.5 ± 1.7. The most frequent complications after TBI and DC were formation of hygroma (83%), aseptic bone resorption of the reimplanted bone flap (50%), posttraumatic hydrocephalus (42%), secondary infection or dysfunction of ventriculoperitoneal shunt (25%) or cranioplasty (33%), and epilepsy (33%). Because of these complications, 75% of patients required further surgery in addition to cranioplasty with up to eight interventions. At follow-up, mean Glasgow Outcome Scale was 3.3 ± 1.2. Within our patient population, we demonstrated high incidence of complications after DC, leading to further surgical procedures and longer hospitalization. These potential complications have to be considered in any decision about DC as an emergency procedure.

Keywords

traumatic brain injury - decompressive craniectomy - children - complications - outcome
 

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