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首页> 外文期刊>British journal of neurosurgery >Decompressive craniectomy in pediatric non-traumatic intracranial hypertension: a single center experience
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Decompressive craniectomy in pediatric non-traumatic intracranial hypertension: a single center experience

机译：儿科非创伤性颅内高血压解压缩颅骨切除术：单一中心经验

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Purpose: To study the clinical profile and predictors of outcome in children undergoing decompressive craniectomy (DC) for non-traumatic intracranial hypertension (ICH). Materials and methods: Mixed observational study of children, aged 1 month-12 years, who underwent DC for non-traumatic ICH in a tertiary care pediatric intensive care unit from 2012 to 2017. Data on clinical profile and outcome were retrieved retrospectively and survivors were assessed prospectively. The primary outcome was neurological outcome using Glasgow Outcome Scale-Extended (GOS-E) at minimum 6 months' post-discharge. GOS-E of 1-4 were classified as a poor and 5-8 as a good outcome. Results: Thirty children, median (IQR) age of 6.5 (2, 50) months, underwent DC; of which 26 (86.7%) were boys. Altered sensorium (n = 26, 86.7%), seizures (n = 25, 83.3%), pallor (n = 19, 63.3%) and anisocoria (n = 14, 46.7%) were common signs and symptoms. Median (IQR) Glasgow Coma Scale at admission was 9 (6,11). Commonest etiology was intracranial bleed (n = 24; 80%). Median (IQR) time to DC was 24 (24,72) h. Eight (26.7%) children died; 2 during PICU stay and 6 during follow-up. Neurological sequelae at discharge (n = 28) were seizures (n = 25; 89.2%) and hemiparesis (n = 16; 57.1%). Twenty-one children were followed-up at median (IQR) duration of 12 (6,54) months. Good neurological outcome was seen in 14/29 (48.2%) and hemiparesis in 10/21 (47.6%) patients. On regression analysis, anisocoria at admission was an independent predictor of poor outcome [OR 7.33; 95%CI: 1.38-38.87; p = 0.019]. Conclusions: DC is beneficial in children with non-traumatic ICH due to a focal pathology and midline shift. Evidence on indications and timing of DC in NTC is still evolving.
机译：目的：研究未创伤性颅内高血压（ICH）进行减压颅骨切除术（DC）的儿童临床概况和预测因子。材料和方法：儿童的混合观察研究，1个月 - 12年，2012年至2017年从高等护理儿科重症监护室中的非创伤性ICH接受了DC。回顾性和幸存者检索有关临床剖面和结果的数据经前评估。主要结果是在排放后至少6个月的延长（GOS-E）的Glasgow结果延伸（GOS-e）的神经态结果。 1-4的GOS-E被归类为穷人，5-8分为良好的结果。结果：30名儿童，中位数（IQR）年龄6.5（2,50）个月，接受了DC;其中26个（86.7％）是男孩。癫痫发作（n = 26,86.7％），粘液（n = 19，63.3％）和癫痫症（n = 14,46.7％），癫痫发育（n = 26,86.7％）是常见的迹象和症状。中位数（IQR）Glasgow Coma Scale在入场时为9（6,11）。最常见的病因是颅内出血（n = 24; 80％）。中位数（IQR）时间为DC为24（24,72）小时。八（26.7％）儿童死亡; 2在PICU停留期间和6次随访期间。癫痫发作（n = 28）的神经系统后遗症（n = 25; 89.2％）和偏瘫（n = 16; 57.1％）。二十一名儿童随访12个月（6,54）个月的中位数（IQR）持续时间。在10/21（47.6％）患者的14/29（48.2％）和偏瘫中看到了良好的神经系统结果。在回归分析中，入学患者是一个独立的预测因子[或7.33; 95％CI：1.38-38.87; p = 0.019]。结论：由于焦点病理和中线转变，DC对非创伤性ICH的儿童有益。 NTC中DC指示和时序的证据仍在不断发展。

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