1299. Distraction Decompressive Craniectomy: A Novel Technique in Avoiding Cranioplasty in Pediatrics

Authors: Amanda Vilate Jenson, MD; Klara Sputova, MD; Raymond Harshbarger, MD; Timothy George, MD (Houston, TX)

Introduction: Decompressive craniectomy with subsequent cranioplasty, either native bone or autologous, is often used in pediatrics following traumatic brain injury with increased intracranial hypertension and cerebral edema. It is well known that in the pediatric population the risks for cranioplasty are much higher than adults; namely, the risk of infection and risk for bone resorption. A recent multicenter retrospective review revealed these numbers to be as high as 8% infection rate and 36% bone resorption rate. Methods: In this 3 patient case series a novel technique to avoid cranioplasty in the pediatric population was established. In order to relieve pressure yet avoid a cranioplasty in the future, a distraction decompressive craniectomy was conducted. This leaves the bone in the patient, attached to the periosteum to still receive blood supply, yet elevated off the brain to relieve pressure via distraction devices implanted. This technique is similar to distraction craniectomies for posterior vault remodeling and craniosynostosis cases but used in the acute setting. Results: This is a safe and effective way to treat traumatic brain injury, increased intracranial hypertension and cerebral edema in the acute setting all while avoiding the need for subsequent cranioplasty. There were no complications and all patients did well. Conclusion: A distraction decompressive craniectomy should be considered for the pediatric population when a decompressive craniectomy is necessary, avoiding altogether the future complications of undergoing a cranioplasty. Further studies with larger sample size should be conducted to further delineate the differences in infection rates, bone resorption rates, and overall morbidity to the patient. Our three cases show that a distraction decompressive craniectomy is well tolerated and safe to perform in the pediatric population.