Delayed bilateral craniectomy for treatment of traumatic brain swelling in children: case report and review of the literature

• Published in: Child's nervous system Vol. 21; no. 3; pp. 249 - 253
• Main Authors: Reithmeier, Thomas, Speder, Bernhard, Pakos, Paul, Brinker, Gerret, Löhr, Mario, Klug, Norfrid, Ernestus, Ralf-Ingo
• Format: Journal Article
• Language: English
• Published: Germany 01.03.2005
• Subjects: Brain Edema - complications; Brain Edema - pathology; Brain Edema - surgery; Brain Injuries - complications; Brain Injuries - pathology; Brain Injuries - surgery; Child; Craniotomy - methods; Female; Glasgow Outcome Scale - statistics & numerical data; Humans; Intracranial Pressure - physiology; Review Literature as Topic; Time Factors; Tomography, X-Ray Computed - methods
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-004-1044-x

Head injury is the leading cause of accidental death in children. Recent reports have shown the benefit of decompressive craniectomy in children and the role of early timing has been emphasized. However, there is still a lack of data to determine the optimal time for performing craniectomy. In contrast to most reports in the literature, this case report demonstrates successful bilateral decompressive craniectomy in a 10-year-old girl with multiple posttraumatic intracranial lesions and massive traumatic brain swelling on the 8th posttraumatic day. Various pathophysiological mechanisms in the genesis of posttraumatic brain swelling make different treatment strategies necessary. Continuous monitoring of intracranial pressure (ICP), as well as serial cranial computed tomography (CCT), can help to differentiate between these mechanisms. Furthermore, repeated clinical and neurophysiological investigations are important for the timing of craniectomy.