Pediatria pre prax 6/2020

Management specifics in paediatric patients with traumatic brain injury and indication for decompressive craniectomy

Due to their incidence and consequences injuries in childhood present a major medical problem. Treatment of the patients often requires considerable costs because of the long term health-care and physiotherapy. The primary goal of the therapy is to protect the brain, decrease the risks of insufficient perfusion, as the main factor in developing a severe neurologic injury. Pediatric intracranial hypertension, as a life-threatening condition, is the subject of an investigation on the field of diagnostics and treatment. The principle of maintaining basic compartments in the enclosed intracranial space is constant and all therapeutic interventions lead to preserve the balance of these compartments, to regulate intracranial pressure to maintain cerebral perfusion pressure. This article deals with traumatic brain injury, focusing on its uniqueness in anatomy, diagnostics and therapy in the child age. We focus mainly on the management of intracranial hypertension using the decompressive craniectomy, with the help of the article’s data from the foreign workplaces. This surgery procedure represents a radical intervention in the treatment of intracranial hypertension, with the need for subsequent intensive care and cranioplasty later on. The result is affected by the timing and technique of the procedure, pediatric patients bear a relatively high incidence of postoperative complications and the need for further reoperation. Correct indication determines good outcome and prognosis. Postoperative care is long-term and requires routine follow-ups and cooperation with pediatric neurologist and psychologist.

Keywords: child’s age, traumatic brain injury, intracranial hypertension, decompressive craniectomy