• A A Figaji, A G Fieggen, A Argent, and J C Peter.
• Divisions of Paediatric Neurourgery and Paediatric Critical Care, School of Child and Adolescent Health, University of Cape Town, and Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa.
• S. Afr. Med. J. 2006 Sep 1;96(9 Pt 2):969-75.

ObjectivesTraumatic brain injury accounts for a high percentage of deaths in children. Raised intracranial pressure (ICP) due to brain swelling within the closed compartment of the skull leads to death or severe neurological disability if not effectively treated. We report our experience with 12 children who presented with cerebral herniation due to traumatic brain swelling in whom decompressive craniectomy was used as an emergency.DesignProspective, observational.SettingRed Cross Children's Hospital.SubjectsChildren with severe traumatic brain injury and cerebral swelling.Outcome MeasuresComputed tomography (CT) scanning, ICP control, clinical outcome.ResultsDespite the very poor clinical condition of these children preoperatively, aggressive management of the raised pressure resulted in unexpectedly good outcomes.ConclusionAggressive surgical measures to decrease ICP in the emergency situation can be of considerable benefit; the key concepts are selection of appropriate patients and early intervention.

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