P119
Titre: Evolution neurologique inattendue après cranioplastie chez un enfant traumatisé crânien grave : cas clinique
Adélie
Christiaens
(Angers, France),
Luc
Le Fournier
(Angers, France),
Charly
Gaisne
(Angers, France),
Marion
Beaumesnil
(Angers, France),
Mathieu
Delion
(Angers, France),
Mickaël
Dinomais
(Angers, France)
Objective :
After a severe Traumatic Brain Injury (TBI), craniectomy is frequently performed to manage uncontrollable intracranial hypertension. Cranioplasty is often performed after craniectomy to repair the resulting skull defect. Several studies have argued that cranioplasty may improve neurological and particularly neuropsychological status of adults after TBI. Very few studies report this neurological evolution after surgery in children. The aim of this work is to discuss the possible role of cranioplasty in children in improving neurological outcomes, illustrated by a case report of one of our patients getting a cranioplasty after a TBI, and presenting an unexpected neurological improvement.
Material / Patients and Methods :
Description of the clinical situation of a 12-year-old severe TBI child in vegetative state undergoing cranioplasty 3 months after craniectomy following a car accident. Comparison of neurological condition before and after surgery.
Results :
Motor evolution: apparition of voluntary movements 3 weeks after surgery. Neuropsychological improvement: Evolution of Wessex Head Injury Matrix (WHIM) score (26/62 three weeks before cranioplasty vs 59/62 one month after surgery), language recovery. Functional changes: Resumption of oral feeding.
Discussion - Conclusion :
These results show that the repair of the cranial defect can trigger relevant neurological improvement in children. This improvement is probably due to changes in the intracranial hemodynamics and in the flow of cerebrospinal fluid after cranioplasty. This reveals the importance of cranioplasty in paediatric rehabilitation programs after a severe TBI to optimise the functional prognosis of patients.
Keywords :
Cranioplasty, craniectomy, TBI, paediatric rehabiliation,