Decompressive craniectomy in children with head trauma

Severe head injury is the leading cause of mortality and severe disability in young people and therefore represents a major public health problem. The escalation of drug therapies to combat intracranial hypertension (ICHT) in children with head trauma is well codified. However, the place of decompressive craniectomy is still not defined. The objective of this work was to evaluate the long-term neurological prognosis of children with severe head injury who required decompressive craniectomy and to identify prognostic factors. We performed a nationwide multicenter retrospective study of 150 patients treated with decompressive craniectomy between 2006 and 2016 at 10 centers in France. Sixty-three percent of patients had a course considered favorable, 20% had a course considered neurologically unfavorable, and mortality was 17%. The place of decompressive craniectomy in the therapeutic arsenal should be reconsidered, especially since, in children, the complication rate is low.