Service de Neurochirurgie, CHU de Nice, Nice, France.
Service de Neurochirurgie Pédiatrique, Hôpital Necker, Paris, France.
World Neurosurg. 2019 Sep;129:e56-e62. doi: 10.1016/j.wneu.2019.04.215. Epub 2019 May 1.
Severe 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.
We 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.
A 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).
This 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.
严重创伤性脑损伤（TBI）是儿童残疾的最常见原因。难治性颅内压增高可能是治疗上的挑战。当药物治疗效果不佳时，可以提出去骨瓣减压术，但在指南中并没有明确其地位。本研究的目的是确定 TBI 患儿的预后因素。
我们进行了一项回顾性多中心研究，分析了 150 例接受去骨瓣减压术治疗的严重 TBI 患儿的长期预后，并确定了预后因素。
62%的患儿出现了满意的神经功能恢复（以 King 儿童头部损伤预后量表评分>3 表示），平均随访 3.5 年。死亡率为 17%。与预后相关的预测因素有年龄、初始格拉斯哥昏迷评分、瞳孔散大、神经监测值（最大颅内压>30mmHg）和影像学表现（鹿特丹评分≥4）。
这项在大样本中的研究证实，接受去骨瓣减压术治疗的严重 TBI 患儿可以获得良好的神经功能预后。需要进一步的研究来阐明该手术在治疗严重 TBI 患儿中的应用。
