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Decompressive craniectomy and CSF disorders in children

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Abstract

Introduction

Decompressive craniectomy (DC) is a lifesaving procedure but is associated to several post-operative complications, namely cerebrospinal fluid (CSF) dynamics impairment. The aim of this multicentric study was to evaluate the incidence of such CSF alterations after DC and review their impact on the overall outcome.

Material and methods

We performed a retrospective multicentric study to analyze the CSF disorders occurring in children aged from 0 to 17 years who had undergone a DC for traumatic brain injury (TBI) in the major Departments of Pediatric Neurosurgery of France between January 2006 and August 2016.

Results

Out of 150 children, ranging in age between 7 months and 17 years, mean 10.75 years, who underwent a DC for TBI in 10 French pediatric neurosurgical centers. Sixteen (6 males, 10 females) (10.67%) developed CSF disorders following the surgical procedure and required an extrathecal CSF shunting. External ventricular drainage increased the risk of further complications, especially cranioplasty infection (p = 0.008).

Conclusion

CSF disorders affect a minority of children after DC for TBI. They may develop early after the DC but they may develop several months after the cranioplasty (8 months), consequently indicating the necessity of clinical and radiological close follow-up after discharge from the neurosurgical unit. External ventricular drainage and permanent CSF shunt placement increase significantly the risk of cranioplasty infection.

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Acknowledgments

The overall series is based on the data obtained from French Pediatric Neurosurgery Departments of Bordeaux, Grenoble, Lille, Lyon, Marseille, Montpellier, Nancy, Nice, Paris, and Toulouse. We thank Dr. Guesmi for her “radiological” support and all the secretaries of the several centers for their help in retrieving the files.

Author information

Authors and Affiliations

  1. Centre Hospitalier Universitaire de Nice, Nice, France

    Marie Manfiotto

  2. Hôpital Femme Mère Enfant, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, 59 Bd Pinel, 69677, Bron Cedex, France

    Carmine Mottolese, Alexandru Szathmari, Pierre-Aurelien Beuriat & Federico Di Rocco

  3. Centre Hospitalier Universitaire de Nancy, Nancy, France

    Olivier Klein

  4. Centre Hospitalier Universitaire de Lille, Lille, France

    Matthieu Vinchon

  5. Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

    Edouard Gimbert

  6. Centre Hospitalier Universitaire de Montpellier, Montpellier, France

    Thomas Roujeau

  7. Centre Hospitalier Universitaire de Marseille, Marseille, France

    Didier Scavarda

  8. Hopital Necker Enfants Malades, Paris, France

    Michel Zerah

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  1. Marie Manfiotto
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Correspondence to Federico Di Rocco.

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Manfiotto, M., Mottolese, C., Szathmari, A. et al. Decompressive craniectomy and CSF disorders in children. Childs Nerv Syst 33, 1751–1757 (2017). https://doi.org/10.1007/s00381-017-3542-7

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  • DOI: https://doi.org/10.1007/s00381-017-3542-7

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