Decompressive craniectomy in pediatric traumatic brain injury: a review of the literature.

BACKGROUND: Pediatric traumatic brain injury accounts for approximately 37,000 hospitalizations and 2,685 deaths in the United State annually. The 2003 guidelines consolidated and summarized the body of literature on this subject. Among the material covered was the role of surgical management of elevated intracranial pressure. Here we review the guideline recommendations, recent literature on the topic, and important recent results in the adult population.

METHODS: A Medline literature review was performed to identify studies published since 2000 addressing decompressive craniectomy in the pediatric and adult populations. Important articles included in the 2003 guidelines were also reviewed. All references were reviewed to identify additional relevant studies.

RESULTS: There is little new data that addresses the key issues for investigation proposed in the 2003 pediatric guidelines. The only randomized trial in the pediatric population remains a 2001 study, which demonstrated a benefit of decompressive craniectomy. One recent randomized trial in adults demonstrated no benefit of the procedure and an additional randomized trial in adults is underway. No pediatric randomized trial is planned. Smaller, non-randomized series appear to support the practice.

CONCLUSION: Based on the only randomized trial in children and the abundance of smaller studies, it is our belief that decompressive craniectomy does provide a benefit in terms of the management of intracranial hypertension and overall outcome in children.