title: Decompressive craniectomy in children:  single-center series and systematic review.
abstract: BACKGROUND
  Decompressive craniectomy (DC) is performed as a life-saving procedure in patients with intractably increased intracranial pressure after traumatic brain injury, bleeding, cerebral infarction, or brain swelling of other causes. However, the application of DC is as controversial in the pediatric population as it is in adults.
  
  
  OBJECTIVE
  To find factors influencing the outcome in pediatric patients who underwent DC because of sustained high intracranial pressure.
  
  
  METHODS
  Between April 2000 and December 2009, 34 pediatric patients (age 0-18 years) underwent DC. Patients were stratified according to the indication for DC. Outcome was assessed according to the modified Rankin Scale score at 6 months. MEDLINE was searched for published studies or reports of DC in pediatric patients to gain a larger population. Two reviewers independently extracted data.
  
  
  RESULTS
  Literature data, including the current series, revealed a total of 172 pediatric patients. Overall, a favorable outcome was achieved in 106 of 172 patients (62%). A favorable outcome was achieved in 25 of 36 patients without traumatic brain injury vs 81 of 136 patients with traumatic brain injury (69% vs 60%). Patients without signs of cerebral herniation had a better outcome than patients with unilateral or bilateral dilated pupils (73% vs 60% vs 45%, respectively).
  
  
  CONCLUSIONS
  The current data indicate that DC in children with traumatic or nontraumatic brain swelling might be warranted, regardless of the underlying cause. Despite mydriasis, a favorable outcome might be achieved in a significant number of pediatric patients. Nevertheless, careful individual decision making is needed for each patient, especially when signs of cerebral herniation have persisted for a long time.
authors.affiliation: Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. Gueresir@em.uni-frankfurt.de
authors.forename: Erdem
authors.initials: E
authors.lastname: Güresir
authors.forename: Patrick
authors.initials: P
authors.lastname: Schuss
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019586:Intracranial Hypertension / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome