Decompressive craniectomy in pediatric TBI

Traumatic brain injury (TBI) is the leading cause of death and disability in children older than age 1, adolescents, and young adults. Pediatric patients have unique anatomical and physiological features that influence their susceptibility to both primary and secondary injury. Although the management of pediatric TBI patients previously had been extrapolated from the adult literature, the importance of research studies and practice protocols that are specific to the pediatric population is becoming increasingly recognized. In particular, the indications, outcomes, and complications of decompressive craniectomy in pediatric TBI patients have been reported by various groups. As a result, decompressive craniectomy has been incorporated into the Guidelines for the Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children, and Adolescents, which recommend that surgery may be considered for pediatric TBI patients who are showing early signs of neurologic deterioration or herniation or are developing intracranial hypertension refractory to medical management during the early stages of their treatment. However, further work is necessary to identify patients who are suitable candidates for decompression, in the ongoing effort to optimize the outcomes of pediatric patients following TBI.