Decompressive craniectomy is a surgical procedure that removes part of the skull to allow room for brain swelling after injury. Not long ago, researchers found that this surgery, although commonly performed, did not actually improve outcome in traumatic brain injury patients. However, that study did not specifically look at the outcomes of decompressive craniectomy in children (under age 12) with traumatic brain injury.
A child's brain is different than an adult's in a few ways: the size is generally smaller, the head is heavier in relation to neck muscles, and the skull may not yet be completely formed. Injury to a child's brain in likewise different than an adult's. Smaller brains are less vulnerable to certain acceleration injuries, but a soft skull is more vulnerable to impact. (These differences are reduced as a child gets older.)
A recent review of past research in children who underwent decompressive craniectomy after a traumatic brain injury found mixed results. Some studies showed both better outcomes, and other studies showed worse. Decompressive craniectomy may remain a controversial surgery, however, some consideration should be given to differences in brain size, development, and response to injury before deciding to proceed.
Appelboom G, Zoller SD, Piazza MA, et al. Traumatic brain injury in pediatric patients: Evidence for the effectiveness of decompressive surgery. Neurosurgical Focus. (November 2011).