The importance of very early decompressive craniectomy as a prevention to avoid the sudden increase of intracranial pressure in children with severe traumatic brain swelling (retrospective case series).
OBJECTIVE
The purpose of the retrospective case series of eight consecutive patients is to call our attention to the optimal timing of decompressive craniectomy (DC) in children.


METHODS
We report the outcomes of eight children under the age of 12 with severe head injuries. DC was performed at different intracranial pressure (ICP; 20 and 25 mmHg) levels.


RESULTS
Our results suggest that above 20 mmHg, very fast progression of ICP (within 15 min) can occur, which may limit the time available to plan and perform DC with a successful patient outcome.


CONCLUSIONS
Considering the anamnestic data, it could be useful to perform DC at 20-22 mmHg ICP in young patients in order to prevent the potential of very fast brain swelling if there is no possibility to perform durotomy within 20 min after the onset of raising the ICP. It is especially considerable in poor countries where the emergency route could be less organized because of locations of building and extreme load of the staff. Further controlled trials are necessary to evaluate the indication and standardization of early decompressive craniectomy as a standard preventive therapy in pediatric severe traumatic brain swelling.
Department of Neurosurgery, BAZ County Hospital, Miskolc, Hungary. csokaya@gmail.com
András
A
Csókay
John Amaechi
JA
Emelifeonwu
László
L
Fügedi
István
I
Valálik
József
J
Láng
D001929:Brain Edema / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D001930:Brain Injuries / Q000150:complications; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000209:etiology* / Q000517:prevention & control*; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D012189:Retrospective Studies