title: Delayed bilateral craniectomy for treatment of traumatic brain swelling in children: case report and review of the literature.
abstract: BACKGROUND
  Head injury is the leading cause of accidental death in children. Recent reports have shown the benefit of decompressive craniectomy in children and the role of early timing has been emphasized. However, there is still a lack of data to determine the optimal time for performing craniectomy.
  
  
  METHODS
  In contrast to most reports in the literature, this case report demonstrates successful bilateral decompressive craniectomy in a 10-year-old girl with multiple posttraumatic intracranial lesions and massive traumatic brain swelling on the 8th posttraumatic day.
  
  
  CONCLUSIONS
  Various pathophysiological mechanisms in the genesis of posttraumatic brain swelling make different treatment strategies necessary. Continuous monitoring of intracranial pressure (ICP), as well as serial cranial computed tomography (CCT), can help to differentiate between these mechanisms. Furthermore, repeated clinical and neurophysiological investigations are important for the timing of craniectomy.
authors.affiliation: Department of Neurosurgery, University of Cologne, Joseph Stelzmann-Strasse 9, 50924, Cologne, Germany. Thomas.Reithmeier@web.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Reithmeier
authors.forename: Bernhard
authors.initials: B
authors.lastname: Speder
authors.forename: Paul
authors.initials: P
authors.lastname: Pakos
authors.forename: Gerret
authors.initials: G
authors.lastname: Brinker
authors.forename: Mario
authors.initials: M
authors.lastname: Löhr
authors.forename: Norfrid
authors.initials: N
authors.lastname: Klug
authors.forename: Ralf-Ingo
authors.initials: RI
authors.lastname: Ernestus
mesh_terms: D001929:Brain Edema / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001930:Brain Injuries / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002648:Child; D003399:Craniotomy / Q000379:methods; D005260:Female; D023261:Glasgow Outcome Scale / Q000706:statistics & numerical data; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D012196:Review Literature as Topic; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods