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.
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: Sacit Bulent Omay; Geneive M Carrión-Grant; Gregory A Kuzmik; Michael Fu; Ryan Grant; Joseph L Schindler; Michael L Diluna; Charles C Duncan; Ketan R Bulsara Journal: Neurosurg Rev Date: 2012-08-11 Impact factor: 3.042