医学
去骨瓣减压术
创伤性脑损伤
颅内压
改良兰金量表
脑肿胀
脑水肿
小儿外伤
人口
外科
儿科
麻醉
毒物控制
伤害预防
急诊医学
内科学
缺血
缺血性中风
精神科
环境卫生
作者
Erdem Güresir,Patrick Schuss,Volker Seifert,Hartmut Vatter
出处
期刊:Neurosurgery
[Oxford University Press]
日期:2012-04-01
卷期号:70 (4): 881-889
被引量:38
标识
DOI:10.1227/neu.0b013e318237a6a6
摘要
BACKGROUND: Decompressive craniectomy (DC) is performed as a life-saving procedure in patients with intractably increased intracranial pressure after traumatic brain injury, bleeding, cerebral infarction, or brain swelling of other causes. However, the application of DC is as controversial in the pediatric population as it is in adults. OBJECTIVE: To find factors influencing the outcome in pediatric patients who underwent DC because of sustained high intracranial pressure. METHODS: Between April 2000 and December 2009, 34 pediatric patients (age 0-18 years) underwent DC. Patients were stratified according to the indication for DC. Outcome was assessed according to the modified Rankin Scale score at 6 months. MEDLINE was searched for published studies or reports of DC in pediatric patients to gain a larger population. Two reviewers independently extracted data. RESULTS: Literature data, including the current series, revealed a total of 172 pediatric patients. Overall, a favorable outcome was achieved in 106 of 172 patients (62%). A favorable outcome was achieved in 25 of 36 patients without traumatic brain injury vs 81 of 136 patients with traumatic brain injury (69% vs 60%). Patients without signs of cerebral herniation had a better outcome than patients with unilateral or bilateral dilated pupils (73% vs 60% vs 45%, respectively). CONCLUSION: The current data indicate that DC in children with traumatic or nontraumatic brain swelling might be warranted, regardless of the underlying cause. Despite mydriasis, a favorable outcome might be achieved in a significant number of pediatric patients. Nevertheless, careful individual decision making is needed for each patient, especially when signs of cerebral herniation have persisted for a long time.
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