Children with Severe Craniocerebral Trauma: Treatment Results

E.I. Usanov, A.I. Tsybizov

(Rauchfus Children’s Municipal Hospital N 19, Saint Petersburg)

Craniocerebral trauma (CCT) in children is an extremely important medical, social and economic problem. It occupies one of the leading positions in the structure of children’s mortality. Cases with its sequelae are the main contingent for treatment both in outpatient departments and children’s neurological, psychiatric and neurosurgical establishments. One more important problem is underestimation of significance of research in the field of medical and social rehabilitation after severe CCT. Life quality of children, who sustained CCT, is no less important. Thus, results of treatment of such casualties demand detailed study.

The present work is based on analysis of multimodality examination and surgical treatment of 86 children, carried out in neurosurgical and resuscitation departments of the Children’s Municipal Hospital N 19 in 2002-2005.

There were 63 boys (73.3%) and 23 girls (26.7%). Their age varied from 0 up to 18 years. The mean age was 8.7±1.0 years. Survival and fatal outcomes were watched in 64 (74.4%) and 22 (25.6%) cases respectively. Boys were predominant in both groups. Vehicle trauma was watched most frequently (53 cases, 61.1%). There were 28 cases with life trauma (32.6%), 1 case with trauma, sustained at school (1.2%), and 2 children with other trauma (2.3%). There was no information on causes of trauma in 2 cases (2.3%).

Isolated CCT and associated trauma of different severity were watched in 30 (34.9%) and 56 (65.1%) casualties respectively. Instrumental examination included craniography, echoencephaloscopy, ultrasonography, CT and MRI of the brain.

All neurosurgical interventions (41) were performed with keeping to the principles of little invasiveness and minimum surgical trauma. Epidural hematomas (16 cases, 39%) were main operative findings. The first and second places were occupied by extracranial (60.5%) and intracranial (39.5%) complications respectively.

We estimated life quality in 46 out of 64 survivors. As compared to a conventional standard, life quality was worse, as cases with sustained CCT experienced lesser popularity and happiness and had reduction of their physical and intellectual status.