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Outcome following decompressive craniectomy for malignant middle cerebral artery infarction in children
Author(s) -
SMITH SABRINA E,
KIRKHAM FENELLA J,
DEVEBER GABRIELLE,
MILLMAN GUY,
DIRKS PETER B,
WIRRELL ELAINE,
TELFEIAN ALBERT E,
SYKES KIM,
BARLOW KAREN,
ICHORD REBECCA
Publication year - 2011
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/j.1469-8749.2010.03775.x
Subject(s) - decompressive craniectomy , glasgow coma scale , medicine , intracranial pressure , coma (optics) , surgery , middle cerebral artery , stroke (engine) , hemiparesis , intracranial pressure monitoring , glasgow outcome scale , decompression , mortality rate , level of consciousness , cerebral infarction , traumatic brain injury , anesthesia , lesion , ischemia , mechanical engineering , physics , psychiatry , optics , engineering
Aim Mortality from malignant middle cerebral artery infarction (MMCAI) approaches 80% in adult series. Although decompressive craniectomy decreases mortality and leads to an acceptable outcome in selected adult patients, there are few data on MMCAI in children with stroke. This study evaluated the frequency of MMCAI and the use of decompressive craniectomy in children. Method We retrospectively reviewed cases of MMCAI from five pediatric tertiary care centers. Results Ten children (two females, eight males; median age 9y 10mo, range 22mo–14y) had MMCAI, with a median Glasgow Coma Scale score of 6 (range 3–9). MMCAI represented fewer than 2% of cases of pediatric arterial ischemic stroke. Three patients who did not undergo decompression, all of whom had monitoring of intracranial pressure, developed intractable intracranial hypertension, and fulfilled criteria for brain death. In contrast, seven patients underwent decompressive craniectomy and survived, with rapid improvement in their level of consciousness postoperatively. All seven survivors now walk independently with mild to moderate residual hemiparesis and speak fluently, even though four had left‐sided infarcts. Interpretation Decompressive craniectomy can lead to a moderately good outcome for children with MMCAI and should be considered, even with symptomatic stroke and deep coma. Monitoring of intracranial pressure may delay life‐saving treatment.