Muhammad Riyaz1, Muhammad Waqas2, Badar Uddin Ujjan3, Naveed Zaman Akhunzada4, Yousaf Bashir Hadi5, Gohar Javed6, Muhammad Ehsan Bari7. 1. Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. riaz_shangla@yahoo.com. 2. Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. shaiq_waqas@hotmail.com. 3. Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. badar.ujjan@aku.edu. 4. Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. naveed.zaman@aku.edu. 5. Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. yousaf.hadi@gmail.com. 6. Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. gohar.javed@aku.edu. 7. Section of Neurosurgery, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan. ehsan.bari@aku.edu.
Abstract
PURPOSE: Management of cerebral edema in infants is challenging. Decompressive craniectomy in young age has shown favorable outcomes for management of intracranial hypertension, but current literature is scarce and consists of only case reports or small series. The purpose of the current study is to report the challenges faced with this procedure and its complications in this peculiar age group. METHODS: This is a retrospective chart review of infants (less than 1 year of age) undergoing unilateral or bilateral decompressive craniotomy at a tertiary care hospital in Pakistan. Kochi score was used to score outcomes of five infants who underwent the procedure. RESULTS: Five infants were included in this series. Operative time for decompressive craniectomy (DC) ranged from 1 h and 40 min to 4 h. Three infants survived to undergo cranioplasty. Two infants recovered with good Kochi scores of 5a and one infant developed hemiparesis (Kochi score 3b). CONCLUSIONS: Decompressive craniectomy carries good outcomes in selected patients. Risk of bleeding and hemodynamic instability makes this procedure challenging. We found coagulopathy in four of the five patients which poses another challenge to the surgical management of these patients and has not been stressed enough in the previous literature.
PURPOSE: Management of cerebral edema in infants is challenging. Decompressive craniectomy in young age has shown favorable outcomes for management of intracranial hypertension, but current literature is scarce and consists of only case reports or small series. The purpose of the current study is to report the challenges faced with this procedure and its complications in this peculiar age group. METHODS: This is a retrospective chart review of infants (less than 1 year of age) undergoing unilateral or bilateral decompressive craniotomy at a tertiary care hospital in Pakistan. Kochi score was used to score outcomes of five infants who underwent the procedure. RESULTS: Five infants were included in this series. Operative time for decompressive craniectomy (DC) ranged from 1 h and 40 min to 4 h. Three infants survived to undergo cranioplasty. Two infants recovered with good Kochi scores of 5a and one infant developed hemiparesis (Kochi score 3b). CONCLUSIONS: Decompressive craniectomy carries good outcomes in selected patients. Risk of bleeding and hemodynamic instability makes this procedure challenging. We found coagulopathy in four of the five patients which poses another challenge to the surgical management of these patients and has not been stressed enough in the previous literature.
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