Beez Thomas, Munoz-Bendix Christopher, Ahmadi Sebastian Alexander, Steiger Hans-Jakob, Beseoglu Kerim
Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
Childs Nerv Syst. 2019 Sep;35(9):1517-1524. doi: 10.1007/s00381-019-04303-z. Epub 2019 Jul 20.
Decompressive craniectomy (DC) is an established neurosurgical emergency technique. Patient selection, optimal timing, and technical aspects related to DC and subsequent cranioplasty remain subjects of debate. For children, the overall degree of evidence is low, compared with randomized controlled trials (RCTs) in adults.
Here, we present a detailed retrospective analysis of pediatric DC, covering the primary procedure and cranioplasty. Results are analyzed and discussed in the light of modern scientific evidence, and conclusions are drawn to stimulate future research.
The main indication for DC in children is traumatic brain injury (TBI). Primary and secondary DC is performed with similar frequency. Outcome appears to be better than that in adults, although long-term complications (especially bone flap resorption after autologous cranioplasty) are more common in children. Overt clinical signs of cerebral herniation prior to DC are predictors of poor outcome.
We conclude that DC is an important option in the armamentarium to treat life-threatening intracranial hypertension, but further research is warranted, preferentially in a multicenter prospective registry.
减压性颅骨切除术（DC）是一种既定的神经外科急救技术。与DC及后续颅骨成形术相关的患者选择、最佳时机和技术方面仍存在争议。与成人的随机对照试验（RCT）相比，儿童的总体证据水平较低。
在此，我们对小儿DC进行了详细的回顾性分析，涵盖初次手术和颅骨成形术。根据现代科学证据对结果进行分析和讨论，并得出结论以推动未来的研究。
儿童DC的主要适应症是创伤性脑损伤（TBI）。初次和二次DC的实施频率相似。尽管长期并发症（尤其是自体颅骨成形术后骨瓣吸收）在儿童中更常见，但结果似乎优于成人。DC前明显的脑疝临床体征是预后不良的预测指标。
我们得出结论，DC是治疗危及生命的颅内高压的重要手段，但有必要进行进一步研究，最好是在多中心前瞻性登记研究中进行。
