Secondary Logo

Institutional members access full text with Ovid®

Perioperative Care for Pediatric Patients With Penetrating Brain Injury

A Review

Mikhael, Marco, MD*; Frost, Elizabeth, MD; Cristancho, Maria, MD*

Journal of Neurosurgical Anesthesiology: October 2018 - Volume 30 - Issue 4 - p 290–298
doi: 10.1097/ANA.0000000000000441
Review Articles

Traumatic brain injury (TBI) continues to be the leading cause of death and acquired disability in young children and adolescents, due to blunt or penetrating trauma, the latter being less common but more lethal. Penetrating brain injury (PBI) has not been studied extensively, mainly reported as case reports or case series, due to the assumption that both types of brain injury have common pathophysiology and consequently common management. However, recommendations and guidelines for the management of PBI differ from those of blunt TBI in regards to neuroimaging, intracranial pressure (ICP) monitoring, and surgical management including those pertaining to vascular injury. PBI was one of the exclusion criteria in the second edition of guidelines for the acute medical management of severe TBI in infants, children, and adolescents that was published in 2012 (it is referred to as “pediatric guidelines” in this review). Many reviews of TBI do not differentiate between the mechanisms of injury. We present an overview of PBI, its presenting features, epidemiology, and causes as well as an analysis of case series and the conclusions that may be drawn from those and other studies. More clinical trials specific to penetrating head injuries in children, focusing mainly on pathophysiology and management, are needed. The term PBI is specific to penetrating injury only, whereas TBI, a more inclusive term, describes mainly, but not only, blunt injury.

*Department of Anesthesiology and Pain Management, Cook County Hospital, Chicago, IL

Icahn Medical Center at Mount Sinai, New York, NY

The authors have no funding or conflicts of interest to disclose.

Address correspondence to: Marco Mikhael, MD, Department of Anesthesiology and Pain Management, Cook County Hospital, 1969 W. Ogden Ave., Chicago, IL 60612 (e-mail:

Received December 23, 2016

Accepted April 10, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved