“Surgical Management of Refractory Intracranial Hypertension in Children: Single-Centre Experience Compared to Current Evidence”

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in the pediatric population worldwide, with long-term consequences affecting neurological, cognitive, and psychosocial development. Moreover, the pediatric brain exhibits unique anatomical and physiological characteristics that influence both the injury pattern and the response to therapy. Thus, these pathophysiological differences require tailored management strategies focused on maintaining optimal intracranial pressure (ICP) and cerebral perfusion pressure (CPP) to limit secondary brain injury. When elevated ICP becomes refractory to medical treatment, decompressive craniectomy (DC) may be considered as a second-tier intervention. While its efficacy is supported by adult trials, pediatric evidence remains still very limited. The impact of DC on long-term neurological outcomes in children remains a topic of active investigation, necessitating further research to clarify indications, timing, and expected benefits in this patient population. This study aims to describe and analyze the experience of the University Hospital of Padua in the management of pediatric patients undergoing decompressive craniectomy. The objective is to compare local clinical outcomes with those reported in the international literature, to highlight similarities, discrepancies, and potential areas for improvement in the therapeutic approach. A retrospective observational study was conducted at the University Hospital of Padova, analyzing medical records of pediatric patients who underwent decompressive craniectomy between January 2012 and December 2024. Inclusion criteria comprised all patients under 16 years of age who received a primary or secondary DC, regardless of the underlying etiology. Clinical and radiological data were extracted from patient electronic charts, together with neuroimaging findings, both pre- and post-operative, as well as clinical outcomes until the last available follow up. Data analysis was made using Microsoft Excel and RStudio and results were compared with findings from the existing literature on pediatric DC, particularly focusing on retrospective cohort studies. Data analysis is currently ongoing. A total of 11 patients, aged between 0 and 13 ± 4 years, were included in the study. Preliminary findings suggest that the clinical characteristics and outcomes observed in the Padua cohort are consistent with those reported in published studies. Early results indicate an association between factors, such as age, GCS at admission, pupillary symmetry and midline shift, and clinical outcome, assessed using the Pediatric Extended Glasgow Outcome Scale (GOSE-Peds). Although data are still being processed, preliminary results appear to align with existing evidence in the literature. Further analysis is expected to provide a more comprehensive understanding of outcome predictors.