• Roberta P Glick, Alexander Ksendzovsky, John Greesh, and Patti Raksin.
• Department of Neurosurgery, Mount Sinai Hospital, Rush Medical College, University of Illinois College of Medicine, Chicago, IL 60608, USA. rpglick@hotmail.com
• Pediatr Neurosurg. 2011 Jan 1;47(2):152-7.

ObjectiveIn the pediatric population, treatment of severely injured children presenting with low Glasgow Coma Score (GCS) and fixed and dilated pupils is controversial. The combination of barbiturate coma and decompressive craniectomy as an aggressive means of controlling intracranial pressure is limited to few studies. In the present series, we report our experience with aggressive combination therapy resulting in good outcomes in pediatric patients with severe traumatic brain injury (TBI).Patients And MethodsSix TBI patients, aged <18 years, either presented with or deteriorated to a GCS <5 with fixed and dilated pupils and CT evidence of surgical lesions with brain edema. Despite hyperventilation, anesthesia, and mannitol, intracranial pressures remained elevated and all patients underwent decompressive craniectomy and external ventricular drainage and were subsequently placed into barbiturate coma for 72 h.ResultsOne patient died and 1 patient remained vegetative. Two patients had excellent recoveries (GOS 5/Rankin 1 or 0, no cognitive deficits) and 2 patients had good recoveries (GOS 4/Rankin 1, mild cognitive deficits).ConclusionsCombination of barbiturate coma with decompressive craniectomy and external ventricular drainage led to good outcomes in a small group of pediatric patients with severe TBI. Based on this series we recommend further investigation into aggressive combination management.Copyright © 2011 S. Karger AG, Basel.

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