title: Decompressive hemicraniectomy and duroplasty in toddlers and preschool children with refractory intracranial hypertension after unilateral hemispheric stroke.
abstract: OBJECTIVE
  Life-threatening hemispheric stroke is associated with a high mortality and morbidity. Decompressive hemicraniectomy has been regarded as an effective treatment option for refractory intracranial hypertension. Here, we reported the clinical course of 5 children with decompressive craniectomy and duroplasty after non-traumatic refractory intracranial hypertension.
  
  
  METHODS
  Four toddlers and one preschool-girl were included in this study; there were 3 boys and 2 girls with a mean age of 34.6 months (range 17-80). Decompressive craniectomy including duroplasty was performed in cases of dilatation of pupil size after intensified standard medical therapy had proven insufficient. All children had a Pediatric Glasgow Coma Scale score <8 at pre-operation state. The mean time-point of craniectomy after stroke attack was 12 hours (range 4-19).
  
  
  RESULTS
  During the long-term follow-up period (mean 47.6 months), no children died. One year later, when we checked their Glasgow Outcome Scale scores, only one toddler received a score of 4 (moderate disability). But the others had good recoveries although they had minor physical or mental deficits. According to the Pediatric Cerebral Performance Category Scale, 4 children received a score of 2 (mild disability).
  
  
  CONCLUSIONS
  Despite our small cases, we suggest that decompressive hemicraniectomy and duroplasty is an acceptable and life-saving treatment for refractory intracranial hypertension after unilateral hemispheric stroke in toddlers and preschool children.
authors.affiliation: Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea.
authors.forename: Sang-Kook
authors.initials: SK
authors.lastname: Lee
authors.forename: Sang-Dae
authors.initials: SD
authors.lastname: Kim
authors.forename: Se-Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Dong-Jun
authors.initials: DJ
authors.lastname: Lim
authors.forename: Jung-Yul
authors.initials: JY
authors.lastname: Park