Citation

Elsawaf Y, Anetsberger S, Luzzi S, Elbabaa SK. World Neurosurg. 2020; ePub(ePub): ePub.

Affiliation

Department of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, FL., USA. Electronic address: samer.elbabaa@gmail.com.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.wneu.2020.02.065

PMID

32084616

Abstract

INTRODUCTION: Severe traumatic brain injuries are a principal cause of neurologic dysfunction and death in the pediatric population. After medical management, the second-tier treatment is decompressive craniectomy in cases of intractable ICP elevation. This literature review offers evidence of early (within 24 hours) and ultra-early (6 to 12 hours) decompressive craniectomy as an effective form of management for severe TBI in the pediatric population.

METHODS: The authors conducted a literature review of articles published from 1996 to 2019 to elucidate neurological outcomes after early decompressive craniectomy in pediatric patients who suffered a severe TBI. Time to decompressive craniectomy and neurological outcomes were recorded and reported descriptively. Qualitative data describes clinically important correlations between preoperative and postoperative ICP levels and improved postoperative neurological outcomes.

RESULTS: Seventy-eight patients were included in this study. The median age of patients at diagnosis was 10 years old (range: 1 months - 19 years old). Median admission GCS was 5 (range: 3-8). Time to decompressive craniectomy ranged from 1 to 24 hours. Median peak preoperative ICP was 40 (range: 3-90, n=49). Median postoperative ICP was 20 (range: 0-80, n=33). Median GOS at discharge was 2 (range: 1-5, n=11). Median GOS at 3- and 6-month follow-up was 3 (n=11). Median GOS at 7 to 23-month follow up was 4 (range: 1-5, n=29). Median GOS at 24 to 83-month follow up was 4 (range: 1-5, n=31). Median Rankin Scale at discharge was 3 (range: 2-4, n=6). Median Rankin Scale at 6 to 48 month follow up was 2 (range: 0-3, n=6). Median Rancho Los Amigos Scale (RLAS) at discharge was 6 (range: 4-8, n=5). Median RLAS at 6 month follow-up was 10 (range: 8-10, n=5).

CONCLUSION: Early (within 24 hours), with consideration of ultra-early (within 6 to 12 hours) decompressive craniectomy for severe traumatic brain injury should be offered to pediatric patients in settings with refractory ICP elevation. Reduction of ICP allows for prompt disruption of pathophysiological cascades and improved neurological outcomes.

Copyright © 2020. Published by Elsevier Inc.

Language: en

Keywords

decompressive craniotomy; pediatric TBI; severe TBI; traumatic brain injury