title: Decompressive craniectomy for infants: a case series of five patients.
abstract: OBJECTIVE
  Management of cerebral edema in infants is challenging. Decompressive craniectomy in young age has shown favorable outcomes for management of intracranial hypertension, but current literature is scarce and consists of only case reports or small series. The purpose of the current study is to report the challenges faced with this procedure and its complications in this peculiar age group.
  
  
  METHODS
  This is a retrospective chart review of infants (less than 1 year of age) undergoing unilateral or bilateral decompressive craniotomy at a tertiary care hospital in Pakistan. Kochi score was used to score outcomes of five infants who underwent the procedure.
  
  
  RESULTS
  Five infants were included in this series. Operative time for decompressive craniectomy (DC) ranged from 1 h and 40 min to 4 h. Three infants survived to undergo cranioplasty. Two infants recovered with good Kochi scores of 5a and one infant developed hemiparesis (Kochi score 3b).
  
  
  CONCLUSIONS
  Decompressive craniectomy carries good outcomes in selected patients. Risk of bleeding and hemodynamic instability makes this procedure challenging. We found coagulopathy in four of the five patients which poses another challenge to the surgical management of these patients and has not been stressed enough in the previous literature.
authors.affiliation: Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. riaz_shangla@yahoo.com.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Riyaz
authors.affiliation: Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. shaiq_waqas@hotmail.com.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Waqas
authors.affiliation: Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. badar.ujjan@aku.edu.
authors.forename: Badar Uddin
authors.initials: BU
authors.lastname: Ujjan
authors.affiliation: Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. naveed.zaman@aku.edu.
authors.forename: Naveed Zaman
authors.initials: NZ
authors.lastname: Akhunzada
authors.affiliation: Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. yousaf.hadi@gmail.com.
authors.forename: Yousaf Bashir
authors.initials: YB
authors.lastname: Hadi
authors.affiliation: Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. gohar.javed@aku.edu.
authors.forename: Gohar
authors.initials: G
authors.lastname: Javed
authors.affiliation: Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. ehsan.bari@aku.edu.
authors.forename: Muhammad Ehsan
authors.initials: ME
authors.lastname: Bari
mesh_terms: D001930:Brain Injuries / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed
keywords: Coagulopathy; Cranioplasty; Decompressive craniectomy; Infants