title: Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery.
abstract: Traumatic brain injury (TBI) is the current leading cause of death in children over 1 year of age. Adequate management and care of pediatric patients is critical to ensure the best functional outcome in this population. In their controversial trial, Cooper et al. concluded that decompressive craniectomy following TBI did not improve clinical outcome of the analyzed adult population. While the study did not target pediatric populations, the results do raise important and timely clinical questions regarding the effectiveness of decompressive surgery in pediatric patients. There is still a paucity of evidence regarding the effectiveness of this therapy in a pediatric population, and there is an especially noticeable knowledge gap surrounding age-stratified interventions in pediatric trauma. The purposes of this review are to first explore the anatomical variations between pediatric and adult populations in the setting of TBI. Second, the authors assess how these differences between adult and pediatric populations could translate into differences in the impact of decompressive surgery following TBI.
authors: Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. ga2294@columbia.ed
authors: Geoffrey
authors: G
authors: Appelboom
authors: Stephen D
authors: SD
authors: Zoller
authors: Matthew A
authors: MA
authors: Piazza
authors: Caroline
authors: C
authors: Szpalski
authors: Samuel S
authors: SS
authors: Bruce
authors: Michael M
authors: MM
authors: McDowell
authors: Kerry A
authors: KA
authors: Vaughan
authors: Brad E
authors: BE
authors: Zacharia
authors: Zachary
authors: Z
authors: Hickman
authors: Anthony
authors: A
authors: D'Ambrosio
authors: Neil A
authors: NA
authors: Feldstein
authors: Richard C E
authors: RC
authors: Anderson
mesh_terms: D000328:Adult; D000367:Age Factors; D001921:Brain / Q000254:growth & development / Q000503:physiopathology / Q000601:surgery; D001929:Brain Edema / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D001930:Brain Injuries / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D056424:Decompressive Craniectomy / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012886:Skull / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery