Analysis of cases with childhood traumatic brain injuries where decompressive craniectomy applied: Prognostic factors and complications and their relationship with craniectomy area

Purpose: Traumatic brain injury is one of the most frequent causes of disability and death in pediatric cases. Decompressive craniectomy is applied as an advanced treatment option to control the increase in intracranial pressure in pediatric patients who are followed up due to severe head trauma. In this study, we investigated the relationship of the prognostic factors and the complications with decompressive craniectomy rate in pediatric cases applying with severe head trauma. Method: Twenty-one pediatric patients aged between 0 and 18 years who underwent decompressive craniectomy and presented for severe head trauma in emergency service between 2013-2018 were retrospectively included in the study. The patients were followed for at least three months. The relationship between the preoperative clinical and radiological data and early and late postoperative and radiological results of the decompressive craniectomy ratio were studied. Findings: The mean age of the patients who applied for emergency was 10.95±5.32, entrance to emergency was GCS 5.16±1.82, and the postoperative third month was GOS 3.09±1.60. In our study, it was observed that as traumatic brain injury Marshall brain tomography score increased, GOS scores decreased. Post-traumatic epilepsy was increased as GOS scores decreased. Hematoma drainage and decompressive craniectomy in patients with intracranial hemorrhage were found to contribute to prognosis. Additional systemic injury in patients had a negative effect on the prognosis. With increasing decompressive craniectomy rate, ventriculo-cephalic index and subdural effusion rate were detected to increase. Decompressive craniectomy rate was not found to be associated with prognosis. Conclusion: In our study, no significant relation was found between decompressive craniectomy rate in pediatric cases and prognosis and complications thereof. The reason of this maybe there were not enough patients. There is a need for an extended study on the rate of decompressive craniectomy in terms of prognosis.