Delayed bilateral craniectomy for treatment of traumatic brain swelling in children

Excerpt

The authors have described a 10-year-old girl who was admitted to a neurosurgical department 1 h after a car accident with bilateral dilated and fixed pupils (GCS=3). CT showed an acute subdural haematoma, which was evacuated. Intracranial pressure (ICP) was monitored, with values below 6 mmHg, and on day 3 ICP started to rise despite active treatment. CT showed diffuse brain swelling. On day 8 ICP values were above 60 mmHg and CT showed massive bilateral brain oedema with compression of the ventricular system. A bilateral fronto-temporal decompressive craniectomy and enlargement of dura were carried out. After decompression ICP dropped immediately to normal values, which is expected—the soft dura and skin tissue carry no resistance pressure. Three months later, the girl was able to stand and walk alone. The 2-year follow-up examination showed that the child was completely integrated socially (GOS=5). …