• A A Figaji, A G Fieggen, A C Argent, P D Le Roux, and J C Peter.
• Division of Neurosurgery, Institute for Child Health, School of Child and Adolescent Health, University of Cape Town, Red Cross Childrens Hospital, Cape Town, South Africa. Anthony.Figaji@uct.ac.za
• Acta Neurochir. Suppl. 2008 Jan 1;102:77-80.

IntroductionThere has been a resurgence of interest in decompressive craniectomy for traumatic brain injury (TBI), but the impact of craniectomy on intracranial pressure (ICP) and cerebral oxygenation has not been well described for diffuse injury in children.MethodsICP and brain tissue oxygenation (PbtO2) changes after decompressive craniectomy for diffuse brain swelling after TBI in children were analysed.FindingsDecompressive craniectomy was performed for diffuse brain swelling in 18 children under 15 years old. For 8 patients, craniectomy was performed as an emergency for malignant brain swelling, and in 10, for sustained ICP > 25 mmHg refractory to conventional medical treatment. In 6 of these patients, PbtO2 was also monitored. Median ICP was reduced from 40 mmHg before craniectomy to 16 mmHg for 24 hours thereafter, and PbtO2 improved from a median of 17.4 to 43.4 mmHg. Clinical outcome was favourable in 78%.ConclusionsIn selected pediatric patients with TBI, craniectomy for diffuse brain swelling can significantly improve ICP and cerebral oxygenation control. The use of the procedure in appropriate settings does not appear to increase the proportion of disabled survivors.

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