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Review
. 2017 Oct;33(10):1745-1750.
doi: 10.1007/s00381-017-3534-7. Epub 2017 Sep 6.

Decompressive craniectomy for traumatic intracranial hypertension: application in children

Adam M H Young  1   2 , Angelos G Kolias  3 , Peter J Hutchinson  3
Affiliations
Review

Decompressive craniectomy for traumatic intracranial hypertension: application in children

Adam M H Young et al. Childs Nerv Syst. 2017 Oct.

Abstract

Traumatic brain injury remains prevalent in children, particularly within the adolescent age group. In severe injury, the priority of treatment is to stabilise the patient initially and prevent the evolution of brain swelling and secondary ischaemia using tiers of medical therapy. The final stage of intervention for such patients is a decompressive craniectomy. Here in, we identify the current evidence for performing decompressive crainectomy in children including the results from the RESCUEicp study.

Keywords: Brain; Craniectomy; Decompression; Injury; Paediatric.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
This figure shows an example monitoring trace of a patient with intracranial hypertension as a result of a traumatic brain injury. The trace demonstrates a sustained plateau of intracranial pressure (blue) that lasts for around 20 min. This is associated with a reduced cerebral perfusion pressure (red), and as a result, the brain’s cerebral autoregulation is non-compliant (green). These are key features that can occur with severe traumatic brain injury and if recurrent would demonstrate potential benefit in undertaking a decompressive craniectomy
Fig. 2
Fig. 2
Representative image of paediatric patients with raised intracranial pressure. a Fourteen-year-old patient with acute subdural haematoma (ASDH), opening ICP 32 mmHg. b Seven-year-old patient with diffuse axonal injury (DAI), opening ICP 38 mmHg. c Twelve-year-old patient with ASDH and DAI opening pressure 35 mmHg. All patients demonstrate open basal cisterns despite pathologically raised ICP
See this image and copyright information in PMC

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