Lacerda GÁJ, Abreu PD, Díaz AJA, Pérez LS, Martín PJC, Martín CD

Language: Spanish
References: 25
Page: 38-43
PDF size: 360.96 Kb.

ABSTRACT

Introduction: Decompressive craniectomy is a surgical procedure used to reduce the refractory intracranial hypertension in children with severe head injuries with good results.
Methods: We have carried out a descriptive study with 12 patients admitted in our pediatric intensive care unit from January 2003 to December 2009 in which an early decompressive craniectomy was performed to reduce the refractory intracranial hypertension.
Results: 66.67 % were between 5–11 years old, initial CT scan showed grade IV diffuse axonal lesion in 50 % of cases, ICP after decompressive craniectomy was less than 20 mm Hg in 66.67 %. GOS at 1 year of evolution showed 58.33 % with grade V and a mortality of 25 % (grade I).
Conclusion: In children who suffered severe head injury with refractory intracranial hypertension, early decompressive craniectomy may be an effective method to treat the secondary deterioration that commonly leads to death or severe neurological deficit.

REFERENCES

1. Tepas JJ, DiScala C, Ramenofsky ML. Mortality and head injury: The pediatric perspective. J Pediatr Surg. 1990;25:92–6.

2. Morrow SE, Pearson M. Management strategies for severe closed head injuries in children. Semin Pediatr Surg. 2010;19(4):279–85.

3. Appelboom G, Zoller SD, Piazza MA, Szpalski C, Bruce SS, McDowell MM, et al. Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery. Neurosurg Focus. 2011;31(5):E5.

4. Abreu Pérez D, Lacerda Gallardo AJ, Montero Álvarez L, Martín Pardo JC. Neuromonitorización y manejo del traumatismo craneoencefálico grave en pediatría. Rev Cub Med Int Emerg. 2010;9(3):1830–41.

5. Chiaretti A, De Benedictis R, Della Corte F, Piastra M, Viola L, Polidori G, et al. The impact of initial management on the outcome of children with head injury. Child´s Nerv Syst. 2002;18:54–60.

6. Cambra FJ, Palomeque A, Muñoz–Santanach D, Segura Matute S, Navarro Balbuena R, García Fructuoso G. Use of decompressive craniectomy in the management of refractory intracranial hypertension in paediatric patients. An Pediatr (Barc). 2010;73(1):12–8.

7. Taylor A, Warwick B, Rosenfeld J. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst. 2001;17:154–62.

8. Polin RS, Shaffrey ME, Bogaev CA. Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery. 1997;41:84–94.

9. Cho DY, Wang YC, Chi CS. Decompressive craniotomy for acute shaken/impact syndrome. Pediatr Neurosurg. 1995;23: 192–8.

10. Oluigbo CO, Wilkinson CC, Stence NV, Fenton LZ, McNatt SA, Handler MH. Comparison of outcomes following decompressive craniectomy in children with accidental and nonaccidental blunt cranial trauma. J Neurosurg Pediatr. 2012;9(2):125–32.

11. Sankhyan N, Vykunta Raju KN, Sharma S, Gulati S. Management of raised intracranial pressure. Indian J Pediatr. 2010;77(12):1409–16.

12. Dizdarevic K, Hamdan A, Omerhodzic I, Kominlija–Smajic E. Modified Lund concept versus cerebral perfusion pressure–targeted therapy: a randomised controlled study in patients with secondary brain ischaemia. Clin Neurol Neurosurg. 2012;114(2):142–8.

13. Marshall LF, Gautille T, Klauber MR, Eisenberg HM, Jane JA, Luersen TG et al. The outcome of severe closed head injury. J Neurosurg. 1991;75:528–36.

14. Adelson PD, Bratton SL, Carney NA, Chesnut RM, Du Coudray HEM, Goldstein B, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents. Pediatr Crit Care Med. 2003;4(3):1–71.

15. Cavuayoaylu H, Kaya RA, Tarkmenoaylu ON, Aydin Y. Value of early unilateral decompressive craniectomy in patients with severe traumatic brain injury. Ulus Travma Acil Cerrahi Derg. 2010;16(2):119–24.

16. Teasdale G, Jennett B. Assesment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–4.

17. Jennet B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975; 1(7905):480–4.

18. Pérez Suárez E, Serrano González A, Pérez Díaz C, García Salido A, Martínez de Azagra Garde A, Casado Flores J. Decompressive craniectomy in 14 children with severe head injury: clinical results with long–term follow–up and review of the literature. J Trauma. 2011;71(1):133–40.

19. Jacob AT, Heuer GG, Grant R, Georgoff P, Danish SF, Storm PB, et al. Decompressive hemicraniectomy for pediatric traumatic brain injury: long–term outcome based on quality of life. Pediatr Neurosurg. 2011;47(2):81–6.

20. Gílresir E, Schuss P, Seifert V, Vatter H. Decompressive craniectomy in children: single–center series and systematic review. Neurosurgery. 2012;70(4):881–9.

21. Abreu Pérez D, Lacerda Gallardo AJ, Ortega Morales A, Díaz Agramonte JA, Miranda Rodríguez G. Craniectomía descompresiva como manejo inicial de la hipertensión endocraneana en el TCE grave en pediatría. Reporte de 5 casos. Rev Invest Medicoquirurg. 2006;3(8):76–7.

22. Csokay A, Emelifeonwu JA, Fílgedi L, Valílik I, Líng J. 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). Childs Nerv Syst. 2012;28(3):441–4.

23. Glick RP, Ksendzovsky A, Greesh J, Raksin P. Initial observations of combination barbiturate coma and decompressive craniectomy for the management of severe pediatric traumatic brain injury. Pediatr Neurosurg. 2011;47(2):152–7.

24. Adamo MA, Drazin D, Waldman JB. Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries. J Neurosurg Pediatr. 2009;3(4):334–9.

25. Duncan CHC, Ment LR, Ogle E. Traumatic injury to the developing brain. En: Marlin AE. eds. Concepts in pediatric neurosurgery. vol.9. Basel: Karger; 1989. p. 211–29.