(744) Decompressive Craniectomy for Stroke and Traumatic Brain Injury: Clinical Features and Outcomes

Introduction: Decompressive craniectomy (DC) is an established but infrequently used intervention in the management of pediatric stroke. While adult studies have associated improved functional outcomes and mortality with expedient DC in acute ischemic stroke, pediatric reports are limited in size and detail. The literature base is more robust with respect to DC in pediatric traumatic brain injury (TBI), which has led some investigators to consider these two populations in tandem. The goal of this retrospective institutional cohort study was to evaluate clinical and radiographic features, time to craniectomy, and functional outcomes in pediatric patients who underwent decompressive craniectomy due to sequelae of stroke and TBI at our institution.

Methods: Children aged 0 to 18 years who were admitted to the pediatric intensive care unit (PICU) after undergoing DC due to TBI or cerebrovascular accident (CVA) were included. A retrospective chart review was performed to acquire clinical data including laboratory values, medications, timing of interventions, and imaging details. Outcome metrics including modified Rankin Scale (mRS) and Functional Status Scale (FSS) scores were obtained or estimated using data from outpatient neurology or physical medicine and rehabilitation visits following hospital discharge.

Results: We reviewed a total of 29 PICU patients who underwent decompressive craniectomies between 2016 and 2020 for ischemic stroke (n=7), hemorrhagic stroke (n=7), or traumatic brain injury (n=15). Ischemic CVA patients were all anterior circulation infarcts (MCA). Median midline shift was 7 mm (IQR +/- 3) and 10 mm (IQR +/- 2.8) for TBI and CVA patients, respectively. Median FSS for the stroke cohort was 11 (IQR +/- 4). Median FSS for the TBI cohort was 10 (IQR +/- 3). Median ICU days for CVA and TBI were 19 (IQR +/- 3) and 16 (IQR +/- 6).

Conclusions: This study is limited by its small sample size and retrospective nature. Further study will aim to evaluate associations between clinical factors and improved functional outcomes in pediatric stroke and TBI patients who undergo decompressive craniectomy.