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Dados do Trabalho
Decompressive craniectomy in children: single center experience and review of the literature.
The goal of this study was to review our cases of decompressive craniectomy (DC) in children with traumatic brain injury (TBI) focusing in mortality, outcome and psychological impairment, comparing the results with literature.
Materiais e Métodos/Casuística
A retrospective study was performed reviewing the medical data for TBI children who were submitted to DC between 2012 and 2015 at our institution. Epidemiological data, mechanism of injury, initial imagining, time until admission and craniectomy, presenting GCS score and hospital course, outcome, mortality and cognitive performance was evaluated. A literature review was carried out until June 2018, including reports of a total of 5 or more patients in the pediatric age group (< 18 years) undergoing decompressive craniectomy with a minimum follow-up of 1 month after the procedure.
16 patients underwent DC for TBI at our institution, 62.5% were males and 37.2% females, mean age was 12 years-old, road traffic accident (RTA) was the main trauma mechanism (62.5%). Average Glasgow coma scale (GCS) was 5.2 with 31.2% of patients presenting pupillary mydriases. Initial cranial computed tomography (CT) showed skull fractures in 62.5% and acute subdural hemorrhage (ASH) in 56.3%. Mean ICP was 27.2 mmHg prior to surgery, mean time to surgery was 36.3 hours, unilateral DC was performed in 68.8% of patients. Mortality after six months was 37.5% and among survivors, Average Glasgow outcome scale (GOS) was 3.7, with good outcomes (GOS 4-5) in 70% of children. Psychological analysis of our surviving patients was abnormal in 55.6% of patients, aggressiveness was present in 22.2%, mild cognitive impairment in 22.2%, vegetative state in 22.2% and severe cognitive impairment in 11.1%.
Discussão e Conclusões
Although children have lower mortality and better outcomes in GOS comparing with adult patients, psychological sequels and their consequences need to be computed in prognosis evaluation.
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Decompressive craniectomy, Traumatic brain injury, Intracranial pressure, Outcome
Department of Surgery and Anatomy, University Hospital of Ribeirão Preto Medical School, University of São Paulo - Sergipe - Brasil, Neurosurgery, Department of Medicine, Federal University of São Carlos - Sao Paulo - Brasil
Matheus Fernando Manzolli Ballestero, Lucas Pires Augusto, Pedro Henrique Carmona Chaves, Marcelo Volpon Santos, Ricardo Santos de Oliveira