The importance of very early decompressive craniectomy as a prevention to avoid the sudden increase of intracranial pressure in children with severe traumatic brain swelling (retrospective case series)

The purpose of the retrospective case series of eight consecutive patients is to call our attention to the optimal timing of decompressive craniectomy (DC) in children. We report the outcomes of eight children under the age of 12 with severe head injuries. DC was performed at different intracranial pressure (ICP; 20 and 25 mmHg) levels. Our results suggest that above 20 mmHg, very fast progression of ICP (within15min) can occur, which may limit the time available to plan and perform DC with a successful patient outcome. Considering the anamnestic data, it could be useful to perform DC at 20-22 mmHg ICP in young patients in order to prevent the potential of very fast brain swelling if there is no possibility to perform durotomy within 20 min after the onset of raising the ICP. It is especially considerable in poor countries where the emergency route could be less organized because of locations of building and extreme load of the staff. Further controlled trials are necessary to evaluate the indication and standardization of early decompressive craniectomy as a standard preventive therapy in pediatric severe traumatic brain swelling.