Right fronto parietal decompressive craniotomy in an 8 years-old child with ICA infarct: An enhanced case report

Abstract

Background: Decompressive craniotomy is a life-saving neurosurgical procedure performed to relieve intracranial hypertension secondary to trauma, infarction, or hemorrhage. This case report presents an 8-yrs-old male who initially had recurrent giddiness and transient limb weakness for 8months, and then developed acute neurological deterioration, fever, and left-sided hemi paresis due to a Right Internal Carotid Artery (ICA) infarct with malignant cerebral edema. Emergency right frontoparietal decompressive craniotomy with brain biopsy and cisternostomy for CSF analysis was performed on August 13, 2025. Postoperatively, the patient required mechanical ventilation and intensive care management, focusing on ICP control with 3% NaCl infusion, anticonvulsants, and immediate physiotherapy. This enhanced case report highlights the importance of early recognition, detailed vascular imaging (MRA/MRV findings suggesting potential Moyamoya Syndrome), and timely surgical intervention in pediatric ICA occlusion leading to malignant cerebral edema.