University of Oulu

Korhonen, T.K., Suo-Palosaari, M., Serlo, W. et al. Favourable long-term recovery after decompressive craniectomy: the Northern Finland experience with a predominantly adolescent patient cohort. Childs Nerv Syst 38, 1763–1772 (2022).

Favourable long-term recovery after decompressive craniectomy : the Northern Finland experience with a predominantly adolescent patient cohort

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Author: Korhonen, Tommi K.1,2; Suo-Palosaari, Maria3; Serlo, Willy4;
Organizations: 1Department of Neurosurgery, Oulu University Hospital, Neurocenter, Oulu, Finland
2Research Unit of Clinical Neuroscience, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
3Department of Diagnostic Radiology, Physics and Technology, Research Unit of Medical Imaging, Oulu University Hospital and University of Oulu, Oulu, Finland
4PEDEGO Research Unit, MRC Oulu, and Department of Children and Adolescents, University of Oulu, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2022-12-28


Purpose: Decompressive craniectomy (DC) is an effective treatment of intracranial hypertension. Correspondingly, the procedure is increasingly utilised worldwide. The number of patients rendered vegetative following surgery has been a concern—a matter especially important in children, due to long anticipated lifetime. Here, we report the long-term outcomes of all paediatric DC patients from an 11-year period in a tertiary-level centre that geographically serves half of Finland.

Methods: We identified all patients younger than 18 years who underwent DC in the Oulu University Hospital between the years 2009 and 2019. Outcomes and clinicoradiological variables were extracted from the patient records.

Results: Mean yearly prevalence of brain injury requiring DC was 1.34/100 000 children—twenty-four patients underwent DC during the study period and 21 (88%) survived. The median age of the patients was 16.0 years, and the median preoperative GCS was 5.0 (IQR 5.0). Fifteen patients (63%) had made a good recovery (Extended Glasgow Outcome Scale ≥ 7). Of the surviving patients, two (9.5%) had not returned to school. After traumatic brain injury (n = 20), the Rotterdam CT score (mean 3.0, range 1 to 5) was not associated with mortality, poor recovery or inability to continue school (p = 0.13, p = 0.41, p = 0.43, respectively). Absent basal cisterns were associated with mortality (p = 0.005), but not with poor recovery if the patient survived DC (p = 0.81). Hydrocephalus was associated with poor recovery and inability to continue school (p = 0.01 and p = 0.03, respectively).

Conclusion: Most of our patients made a favourable recovery and were able to continue school. No late mortality was observed. Thus, even in clinically and radiologically severely brain-injured children, decompressive craniectomy appears to yield favourable outcomes.

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Series: Child's nervous system
ISSN: 0256-7040
ISSN-E: 1433-0350
ISSN-L: 0256-7040
Volume: 38
Issue: 9
Pages: 1763 - 1772
DOI: 10.1007/s00381-022-05568-7
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
3124 Neurology and psychiatry
Funding: Open Access funding provided by University of Oulu including Oulu University Hospital. TKK received research grant funding from the Finnish Medical Foundation (grant no. 4268) and The Finnish Cultural Foundation.
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