REVERSIBILITY OF SEVERE BRAIN-STEM DYSFUNCTION IN CHILDREN

The very popular concept of brain death can lead to a defeatist attitu de when confronted by a patient with severe brain stem dysfunction. Th is problem is compounded by the constant controversy surrounding the e stablishing of criteria to determine brain death. Many young doctors t end to accept the precondition of irreversibility as being any conditi on that is not explicitly listed in the examples of potentially revers ible conditions. In children, however, with compressive brain stem dys function, decompressive surgery can lead to a reversal of the dysfunct ion. In the last three years, we have had the opportunity to observe 5 children who were deeply comatose and apnoeic. All were suffering fro m compression of the brain stem and experienced dramatic return of bra in stem function following emergency decompression. The implications o f these findings on the therapeutic attitude towards compressive brain stem lesions in children are exposed. In children with severe brain s tem dysfunction, and no evidence of brain stem destruction, decompress ive surgery should be undertaken before a diagnosis of brain death is considered.