[Use of decompressive craniectomy in the management of refractory intracranial hypertension in paediatric patients].
OBJECTIVE
Intracranial hypertension (ICH) is the main cause of morbidity and mortality in patients with severe traumatic head injuries. Decompressive craniectomy (DC) is a surgical technique that allows to reduce intracranial pressure (ICP) and to improve cerebral blood flow.


OBJECTIVE
To present our experience on DC for the treatment of ICH.


METHODS
Retrospective review of patients admitted from January 2005 to December 2008 who had a traumatic brain injury (TBI) and uncontrollable intracranial hypertension despite optimal medical treatment and who needed DC.


RESULTS
Fourteen patients with severe TBI were included in this series. Mean age was 14.2 years (4-20 years). The more frequent damages detected in cranial computerized tomography were diffuse brain lesions types II and III. Indication for DC was made if ICP levels were above 25 mmHg for more than 30 min despite optimal medical treatment. Clinical outcome was favourable in all patients apart from two. Neurological outcome was correct in 78.8% of patients (Glasgow Outcome Score 4 and 5) six months after PICU discharge.


CONCLUSIONS
DC is an alternative for the management of refractory intracranial hypertension in children and adolescents with severe TBI. It could be used simultaneously with the barbiturate coma or as an alternative, particularly in haemodynamically unstable patients.
Cambra
F J
FJ
Unidad de Cuidados Intensivos Pediátricos, Esplugues de Llobregat, Barcelona, España. fjcambra@hsjdbcn.org
Palomeque
A
A
Muñoz-Santanach
D
D
Segura Matute
S
S
Navarro Balbuena
R
R
García Fructuoso
G
G
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult