Outcomes after decompressive craniectomy for severe traumatic brain injury in children

Update item information
Publication Type Journal Article
School or College School of Medicine
Department Neurosurgery
Creator Kestle, John R. W.; Brockmeyer, Douglas Lee
Other Author Kan, Peter; Amini, Aminullah; Hansen, Kristine; White Jr., George L.; Walker, Marion L.
Title Outcomes after decompressive craniectomy for severe traumatic brain injury in children
Date 2006
Description Object. Severe traumatic brain injury (TBI) is often accompanied by early death due to transtentorial herniation. Decompressive craniectomy, performed alone or in conjunction with evacuation of the mass lesion, can reduce the incidence of raised intracranial pressure (ICP). In this paper the authors evaluate mortality and morbidity and long-term outcomes in children who underwent decompressive craniectomy for severe TBI at a single institution. Methods. Children with severe TBI who underwent decompressive craniectomy at the Primary Children's Medical Center between 1996 and 2005 were identified retrospectively. Descriptive statistics were used to report postoperative mortality and morbidity rates. Long-term recovery in patients who survived was reported using the King's Outcome Scale for Closed Head Injury (KOSCHI). Fifty-one children with a mean follow-up period of 18.6 months were identified. Nonaccidental trauma accounted for 23.5% of cases. The mean preoperative Glasgow Coma Scale (GCS) score was 4.6. Six patients underwent decompressive craniectomy for elevated ICP only; all other patients underwent decompressive craniectomy in conjunction with removal of the mass lesion. The mean postoperative GCS score was 9.7, and 69.4% of patients had normal ICP levels immediately after surgery. Sixteen children (31.4%) died, including five of six children who underwent decompressive craniectomy for raised ICP alone. Among surviving patients, 2.9% required a tracheostomy, 11.4% required a gastrostomy, 40% experienced posttraumatic shunt-dependent hydrocephalus, and 20% suffered posttraumatic epilepsy requiring antiepileptic agents. The mean KOSCHI score at the last follow-up examination was 4.5 and the mean time to cranioplasty was 2.3 months. Conclusions. Posttraumatic hydrocephalus and epilepsy were common complications encountered by children with severe TBI who underwent decompressive craniectomy. In patients who underwent decompressive surgery for raised ICP only, the mortality rate was exceedingly high.
Type Text
Publisher American Association of Neurological Surgeons (AANS)
Volume 105
Issue 5 Suppl
First Page 337
Last Page 342
Subject Traumatic brain injury; Decompressive craniectomy; Pediatric neurosurgery
Subject LCSH Pediatric neurology; Brain -- Wounds and injuries; Skull -- Surgery; Outcome assessment (Medical care)
Language eng
Bibliographic Citation Kan, P., Amini, A., Hansen, K., White Jr., G. L., Brockmeyer, D. L., Walker, M. L., & Kestle, J. R. W. (2006). Outcomes after decompressive craniectomy for severe traumatic brain injury in children. Journal of Neurosurgery, 105(5 Suppl), 337-42.
Rights Management (c) American Association of Neurological Surgeons
Format Medium application/pdf
Format Extent 200,975 bytes
Identifier ir-main,13208
ARK ark:/87278/s65t43kq
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2012-06-13
ID 702389
Reference URL https://collections.lib.utah.edu/ark:/87278/s65t43kq
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