title: Surgical results of decompressive craniectomy in very young children: A level one trauma centre experience from India.
abstract: BACKGROUND
  Literature remains sparse regarding decompressive craniectomy (DC) in traumatic brain injury (TBI) in very young children. This study analysed the indications, complications and outcome of young children undergoing DC for TBI at our institute.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  The total number of patients was 71. Mean age was 1.6 years. Mean duration from injury to surgery was 11.9 hours (range = 3-80 hours). Around 50% had severe head injury. Intracranial pressure (ICP) monitoring was done in 33 patients. Mean ICP was 22.2 mm Hg (range = 9-50 mm Hg). The threshold ICP for surgery was 15 mm Hg. Perioperative mortality was 50% each for severe TBI (18/36) and diffuse cerebral edema (7/14), and 58% for infants (4/7). Ninety per cent of expired patients had ICP > 20 mm Hg. Mean follow-up duration was 19.6 months (range = 2-42 months). Except one, all survivors had good-to-excellent outcomes (Glasgow outcome scale extended; GOS-E = 7-8).
  
  
  CONCLUSIONS
  Decompressive craniectomy offers a survival advantage in almost 50% of young children with severe TBI and should be used judiciously. The highest mortality was within the 1st week of surgery. The cut-off limit of 20 mm Hg for surgical decompression might not be applicable to young children and a low threshold ICP needs to be considered. Factors associated with increased mortality are high opening ICP (>20 mm Hg), GCS <8, diffuse cerebral oedema and infant age group. Timing of DC remains crucial. Further prospective studies are necessary to optimize the timing and ICP limit for surgical decompression.
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre , AlIMS, Raj Nagar , New Delhi , India.
authors.forename: G Lakshmi
authors.initials: GL
authors.lastname: Prasad
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre , AlIMS, Raj Nagar , New Delhi , India.
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Gupta
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre , AlIMS, Raj Nagar , New Delhi , India.
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Mahapatra
authors.affiliation: a Department of Neurosurgery , Jai Prakash Narayan Apex Trauma Centre , AlIMS, Raj Nagar , New Delhi , India.
authors.forename: Bhawani Shankar
authors.initials: BS
authors.lastname: Sharma
mesh_terms: D000367:Age Factors; D001929:Brain Edema / Q000209:etiology; D001930:Brain Injuries / Q000503:physiopathology / Q000601:surgery*; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D019586:Intracranial Hypertension / Q000209:etiology / Q000601:surgery; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D012189:Retrospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome
keywords: Decompressive craniectomy; intracranial hypertension; intracranial pressure monitoring; paediatric; traumatic; young children