Reversibility of severe brain stem dysfunction in children.

The very popular concept of brain death can lead to a defeatist attitude when confronted by a patient with severe brain stem dysfunction. This problem is compounded by the constant controversy surrounding the establishing of criteria to determine brain death. Many young doctors tend to accept the precondition of irreversibility as being any condition that is not explicitly listed in the examples of potentially reversible conditions. In children, however, with compressive brain stem dysfunction, decompressive surgery can lead to a reversal of the dysfunction. In the last three years, we have had the opportunity to observe 5 children who were deeply comatose and apnoeic. All were suffering from compression of the brain stem and experienced dramatic return of brain stem function following emergency decompression. The implications of these findings on the therapeutic attitude towards compressive brain stem lesions in children are exposed. In children with severe brain stem dysfunction, and no evidence of brain stem destruction, decompressive surgery should be undertaken before a diagnosis of brain death is considered.