Decompressive craniectomy in pediatric patients

More frequently than adults, pediatric victims of severe traumatic brain injury experience diffuse severe cerebral edema without mass lesions. These patients require methods to reduce intracranial pressure quickly and reliably. Surgical decompression provides rapid relief of increased intracranial pressure and is an alternative to maximal medical therapy for these individuals. Based on previous trials, most of which are anecdotal but now include attempts at case controlled and cohort matched investigations, Ruf and colleagues describe a series of six pediatric patients treated with a prospectively implemented protocol of decompressive craniectomy for severe traumatic brain injury. The heterogeneous approaches presented (which include hemicraniectomy, bifrontal craniectomy, and suboccipital craniectomy) undermine the applicability of the results. However, this report, coupled with similar papers, does highlight the need for a true controlled trial of this modality to examine whether craniectomy can emerge as more than a second line option for the management of increased intracranial pressure.