Bifrontal decompressive craniotomy in a 6-month-old infant with posttraumatic refractory intracranial hypertension.

OBJECTIVE

To document the outcome of bifrontal decompressive craniotomy (BDC) in an infant who developed refractory intracranial hypertension (IH) and massive brain infarction following severe head injury.

CLINICAL PRESENTATION: A 6-month-old girl sustained a severe closed head injury in a car accident. Her Glasgow coma score dropped from 10 to 6/15 within 6 h after admission, and her pupils became dilated and fixed. CT brain scans showed severe brain swelling and extensive infarction in both cerebral hemispheres with no grey-white mater differentiation. She developed a state of refractory IH despite maximal medical treatment.

INTERVENTION: She had BDC and duraplasty carried out 8 h after admission. She made a quick recovery to Glasgow outcome score 3, and her total hospital stay was 10 weeks.

CONCLUSION

BDC can be a life-saving procedure for infants with refractory IH and massive brain infarction.