Decompressive craniectomy in children with nontraumatic refractory high intracranial pressure. Clinical article.

Abstract

OBJECT:

In this study, the authors investigated the clinical efficacy of decompressive craniectomy treatments for nontraumatic intracranial hypertension in children.

METHODS:

Seven patients with nontraumatic refractory high intracranial pressure (ICP) were enrolled in the study between 1995 and 2005; there were 2 boys and 5 girls with a mean age of 9 years (range 4-14). Decompressive craniectomy was performed in all patients after standard medical therapy had proven insufficient and ICP remained > 50 mm Hg. All patients had a Glasgow Coma Scale score < 8 at admission and a mean Pediatric Risk of Mortality Scale score of 20 (range 10-27).

RESULTS:

One patient died of persistent high ICP and circulatory failure 48 hours after surgery. Six months later, according to their Glasgow Outcome Scale scores, 3 patients had adequate recoveries, 2 patients recovered with moderate disabilities, and 1 patient had severe disabilities. According to the Pediatric Overall Performance Category Scale, 4 patients received a score of 2 (mild disability), 1 a score of 3 (moderate disability), and 1 a score of 4 (severe disability). Five patients returned to school and normal life.

CONCLUSIONS:

The authors found decompressive craniectomy to be an effective and lifesaving technique in children. This procedure should be included in the arsenal of treatments for nontraumatic intracranial hypertension.

• Authors: Nozar Aghakhani, Philippe Durand, Laurent Chevret, Fabrice Parker, Denis Devictor, Marc Tardieu, Marc Tadié
• Journal: Journal of neurosurgery. Pediatrics (J Neurosurg Pediatr) Vol. 3 Issue 1 Pg. 66-9 (Jan 2009) ISSN: 1933-0707 [Print] United States
• PMID: 19119908 (Publication Type: Journal Article)

Topics

• Adolescent
• Child
• Child, Preschool
• Craniotomy (methods)
• Decompression, Surgical (methods)
• Disability Evaluation
• Female
• Glasgow Outcome Scale
• Humans
• Intensive Care Units, Pediatric
• Intracranial Hypertension (etiology, surgery)
• Male
• Neurologic Examination
• Neuronavigation (methods)
• Postoperative Complications (diagnosis)
• Treatment Outcome