Surgical treatment for "brain compartment syndrome" in children with severe head injury.

OBJECTIVES Traumatic brain injury accounts for a high percentage of deaths in children. Raised intracranial pressure (ICP) due to brain swelling within the closed compartment of the skull leads to death or severe neurological disability if not effectively treated. We report our experience with 12 children who presented with cerebral herniation due to traumatic brain swelling in whom decompressive craniectomy was used as an emergency. DESIGN Prospective, observational. SETTING Red Cross Children's Hospital. SUBJECTS Children with severe traumatic brain injury and cerebral swelling. OUTCOME MEASURES Computed tomography (CT) scanning, ICP control, clinical outcome. RESULTS Despite the very poor clinical condition of these children preoperatively, aggressive management of the raised pressure resulted in unexpectedly good outcomes. CONCLUSION Aggressive surgical measures to decrease ICP in the emergency situation can be of considerable benefit; the key concepts are selection of appropriate patients and early intervention.