Outcome following decompressive craniectomy for malignant middle cerebral artery infarction in children.

Publication/Presentation Date

1-1-2011

Abstract

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.

Volume

53

Issue

1

First Page

29

Last Page

33

ISSN

1469-8749

Disciplines

Medicine and Health Sciences | Pediatrics

PubMedID

20804513

Department(s)

Department of Pediatrics

Document Type

Article

Link to Full Text

Share

COinS