Decompressive Craniotomy in Children

Decompressive craniotomy (DCO) is a neurosurgical procedure executed to reduce medically refractory raised intracranial pressure. In order to house the swollen area, it is typically advised in situations of acute subdural hematoma (ASDH), traumatic brain injury (TBI), or even for non-traumatic lesions. Studies have described and suggested taking the potential benefits of DCO without bone removal among infants and children. The most common indications for DCO are ASDH following TBI. Several techniques have been described in the existing literature though standard procedure is yet to be determined due to lack of large-scale studies. Though DCO is considered superior to craniectomy considering preoperative complications and postoperative long-term outcomes, after the procedure, a variety of problems and negative outcomes might occur. The most prevalent complications are superficial infections, hydrocephalus, subdural effusions, and deep-seated infections such as meningitis. Patients with TBI and stroke urgently require cost-effective surgical care, especially in low- and middle-income countries, where the burden of disease is rising. Additional research would be required to reduce post-craniotomy complications and favorable neurological outcomes.