Bifrontal decompressive craniotomy in a 6-month-old infant with posttraumatic refractory intracranial hypertension

Abstract

Objective: To document the outcome of bifrontal decompressive craniotomy (BDC) in an infant who developed refractory intracranial hypertension (IH) and massive brain infarction following severe head injury.

Clinical presentation: A 6-month-old girl sustained a severe closed head injury in a car accident. Her Glasgow coma score dropped from 10 to 6/15 within 6 h after admission, and her pupils became dilated and fixed. CT brain scans showed severe brain swelling and extensive infarction in both cerebral hemispheres with no grey-white mater differentiation. She developed a state of refractory IH despite maximal medical treatment.

Intervention: She had BDC and duraplasty carried out 8 h after admission. She made a quick recovery to Glasgow outcome score 3, and her total hospital stay was 10 weeks.

Conclusion: BDC can be a life-saving procedure for infants with refractory IH and massive brain infarction.