Surgical results of decompressive craniectomy in very young children

A level one trauma centre experience from India

G. Lakshmi Prasad, Deepak Kumar Gupta, Ashok Kumar Mahapatra, Bhawani Shankar Sharma

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: Literature remains sparse regarding decompressive craniectomy (DC) in traumatic brain injury (TBI) in very young children. This study analysed the indications, complications and outcome of young children undergoing DC for TBI at our institute.Study design: Retrospective.Observations: The total number of patients was 71. Mean age was 1.6 years. Mean duration from injury to surgery was 11.9 hours (range = 3-80 hours). Around 50% had severe head injury. Intracranial pressure (ICP) monitoring was done in 33 patients. Mean ICP was 22.2 mm Hg (range = 9-50 mm Hg). The threshold ICP for surgery was 15 mm Hg. Perioperative mortality was 50% each for severe TBI (18/36) and diffuse cerebral edema (7/14), and 58% for infants (4/7). Ninety per cent of expired patients had ICP > 20 mm Hg. Mean follow-up duration was 19.6 months (range = 2-42 months). Except one, all survivors had good-to-excellent outcomes (Glasgow outcome scale extended; GOS-E = 7-8).Conclusions: Decompressive craniectomy offers a survival advantage in almost 50% of young children with severe TBI and should be used judiciously. The highest mortality was within the 1st week of surgery. The cut-off limit of 20 mm Hg for surgical decompression might not be applicable to young children and a low threshold ICP needs to be considered. Factors associated with increased mortality are high opening ICP (>20 mm Hg), GCS <8, diffuse cerebral oedema and infant age group. Timing of DC remains crucial. Further prospective studies are necessary to optimize the timing and ICP limit for surgical decompression.

Original languageEnglish
Pages (from-to)1717-1724
Number of pages8
JournalBrain Injury
Volume29
Issue number13-14
DOIs
Publication statusPublished - 06-12-2015

Fingerprint

Decompressive Craniectomy
Trauma Centers
Intracranial Pressure
India
Surgical Decompression
Brain Edema
Mortality
Glasgow Outcome Scale
Craniocerebral Trauma
Survivors
Retrospective Studies
Age Groups
Prospective Studies
Survival
Traumatic Brain Injury
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Neuroscience (miscellaneous)
  • Developmental and Educational Psychology
  • Clinical Neurology

Cite this

Prasad, G. Lakshmi ; Gupta, Deepak Kumar ; Mahapatra, Ashok Kumar ; Sharma, Bhawani Shankar. / Surgical results of decompressive craniectomy in very young children : A level one trauma centre experience from India. In: Brain Injury. 2015 ; Vol. 29, No. 13-14. pp. 1717-1724.
@article{99b91e51650a453ba8f9d954b26e810f,
title = "Surgical results of decompressive craniectomy in very young children: A level one trauma centre experience from India",
abstract = "Introduction: Literature remains sparse regarding decompressive craniectomy (DC) in traumatic brain injury (TBI) in very young children. This study analysed the indications, complications and outcome of young children undergoing DC for TBI at our institute.Study design: Retrospective.Observations: The total number of patients was 71. Mean age was 1.6 years. Mean duration from injury to surgery was 11.9 hours (range = 3-80 hours). Around 50{\%} had severe head injury. Intracranial pressure (ICP) monitoring was done in 33 patients. Mean ICP was 22.2 mm Hg (range = 9-50 mm Hg). The threshold ICP for surgery was 15 mm Hg. Perioperative mortality was 50{\%} each for severe TBI (18/36) and diffuse cerebral edema (7/14), and 58{\%} for infants (4/7). Ninety per cent of expired patients had ICP > 20 mm Hg. Mean follow-up duration was 19.6 months (range = 2-42 months). Except one, all survivors had good-to-excellent outcomes (Glasgow outcome scale extended; GOS-E = 7-8).Conclusions: Decompressive craniectomy offers a survival advantage in almost 50{\%} of young children with severe TBI and should be used judiciously. The highest mortality was within the 1st week of surgery. The cut-off limit of 20 mm Hg for surgical decompression might not be applicable to young children and a low threshold ICP needs to be considered. Factors associated with increased mortality are high opening ICP (>20 mm Hg), GCS <8, diffuse cerebral oedema and infant age group. Timing of DC remains crucial. Further prospective studies are necessary to optimize the timing and ICP limit for surgical decompression.",
author = "Prasad, {G. Lakshmi} and Gupta, {Deepak Kumar} and Mahapatra, {Ashok Kumar} and Sharma, {Bhawani Shankar}",
year = "2015",
month = "12",
day = "6",
doi = "10.3109/02699052.2015.1075146",
language = "English",
volume = "29",
pages = "1717--1724",
journal = "Brain Injury",
issn = "0269-9052",
publisher = "Informa Healthcare",
number = "13-14",

}

Surgical results of decompressive craniectomy in very young children : A level one trauma centre experience from India. / Prasad, G. Lakshmi; Gupta, Deepak Kumar; Mahapatra, Ashok Kumar; Sharma, Bhawani Shankar.

In: Brain Injury, Vol. 29, No. 13-14, 06.12.2015, p. 1717-1724.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Surgical results of decompressive craniectomy in very young children

T2 - A level one trauma centre experience from India

AU - Prasad, G. Lakshmi

AU - Gupta, Deepak Kumar

AU - Mahapatra, Ashok Kumar

AU - Sharma, Bhawani Shankar

PY - 2015/12/6

Y1 - 2015/12/6

N2 - Introduction: Literature remains sparse regarding decompressive craniectomy (DC) in traumatic brain injury (TBI) in very young children. This study analysed the indications, complications and outcome of young children undergoing DC for TBI at our institute.Study design: Retrospective.Observations: The total number of patients was 71. Mean age was 1.6 years. Mean duration from injury to surgery was 11.9 hours (range = 3-80 hours). Around 50% had severe head injury. Intracranial pressure (ICP) monitoring was done in 33 patients. Mean ICP was 22.2 mm Hg (range = 9-50 mm Hg). The threshold ICP for surgery was 15 mm Hg. Perioperative mortality was 50% each for severe TBI (18/36) and diffuse cerebral edema (7/14), and 58% for infants (4/7). Ninety per cent of expired patients had ICP > 20 mm Hg. Mean follow-up duration was 19.6 months (range = 2-42 months). Except one, all survivors had good-to-excellent outcomes (Glasgow outcome scale extended; GOS-E = 7-8).Conclusions: Decompressive craniectomy offers a survival advantage in almost 50% of young children with severe TBI and should be used judiciously. The highest mortality was within the 1st week of surgery. The cut-off limit of 20 mm Hg for surgical decompression might not be applicable to young children and a low threshold ICP needs to be considered. Factors associated with increased mortality are high opening ICP (>20 mm Hg), GCS <8, diffuse cerebral oedema and infant age group. Timing of DC remains crucial. Further prospective studies are necessary to optimize the timing and ICP limit for surgical decompression.

AB - Introduction: Literature remains sparse regarding decompressive craniectomy (DC) in traumatic brain injury (TBI) in very young children. This study analysed the indications, complications and outcome of young children undergoing DC for TBI at our institute.Study design: Retrospective.Observations: The total number of patients was 71. Mean age was 1.6 years. Mean duration from injury to surgery was 11.9 hours (range = 3-80 hours). Around 50% had severe head injury. Intracranial pressure (ICP) monitoring was done in 33 patients. Mean ICP was 22.2 mm Hg (range = 9-50 mm Hg). The threshold ICP for surgery was 15 mm Hg. Perioperative mortality was 50% each for severe TBI (18/36) and diffuse cerebral edema (7/14), and 58% for infants (4/7). Ninety per cent of expired patients had ICP > 20 mm Hg. Mean follow-up duration was 19.6 months (range = 2-42 months). Except one, all survivors had good-to-excellent outcomes (Glasgow outcome scale extended; GOS-E = 7-8).Conclusions: Decompressive craniectomy offers a survival advantage in almost 50% of young children with severe TBI and should be used judiciously. The highest mortality was within the 1st week of surgery. The cut-off limit of 20 mm Hg for surgical decompression might not be applicable to young children and a low threshold ICP needs to be considered. Factors associated with increased mortality are high opening ICP (>20 mm Hg), GCS <8, diffuse cerebral oedema and infant age group. Timing of DC remains crucial. Further prospective studies are necessary to optimize the timing and ICP limit for surgical decompression.

UR - http://www.scopus.com/inward/record.url?scp=84951907451&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84951907451&partnerID=8YFLogxK

U2 - 10.3109/02699052.2015.1075146

DO - 10.3109/02699052.2015.1075146

M3 - Article

VL - 29

SP - 1717

EP - 1724

JO - Brain Injury

JF - Brain Injury

SN - 0269-9052

IS - 13-14

ER -