• Marie Manfiotto, Kevin Beccaria, Alice Rolland, Giovanna Paternoster, Benjamin Plas, Sergio Boetto, Mathieu Vinchon, Carmine Mottolese, Pierre-Aurélien Beuriat, Alexandru Szathmari, Federico Di Rocco, Didier Scavarda, Eric Seigneuret, Isabelle Wrobleski, Olivier Klein, Antony Joud, Edouard Gimbert, Vincent Jecko, Jean Rodolphe Vignes, Thomas Roujeau, Audrey Dupont, Michel Zerah, and Michel Lonjon.
• Service de Neurochirurgie, CHU de Nice, Nice, France. Electronic address: marie.manfiotto@hotmail.com.
• World Neurosurg. 2019 Sep 1; 129: e56-e62.

BackgroundSevere traumatic brain injury (TBI) is the most common cause of disability in children. Refractory increased intracranial pressure can be a therapeutic challenge. Decompressive craniectomy can be proposed when medical management is insufficient, but its place is not clearly defined in guidelines. The aim of this study was to identify prognostic factors in children with TBI.MethodsWe performed a retrospective, multicenter study to analyze long-term outcomes of 150 children with severe TBI treated by decompressive craniectomy and to identify prognostic factors.ResultsA satisfactory neurologic evolution (represented by a King's Outcome Scale for Childhood Head Injury score >3) was observed in 62% of children with a mean follow-up of 3.5 years. Mortality rate was 17%. Prognostic factors associated with outcome were age, initial Glasgow Coma Scale score, presence of mydriasis, neuromonitoring values (maximal intracranial pressure >30 mm Hg), and radiologic findings (Rotterdam score ≥4).ConclusionsThis study in a large population confirms that children with severe TBI treated by decompressive craniectomy can achieve a good neurologic outcome. Further studies are needed to clarify the use of this surgery in the management of children with severe TBI.Copyright © 2019 Elsevier Inc. All rights reserved.

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