Connecting raised intracranial pressure and cognitive delay in craniosynostosis: many assumptions, little evidence

Hayward, Richard; Britto, Jonathan A.; Dunaway, David; Jeelani, Owase

doi:10.3171/2015.6.peds15144

Cited by 36 publications

(41 citation statements)

References 81 publications

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“…Craniotomies for intracranial hypertension were merged into a stand-alone category, irrespective of suture involvement or whether they were done as a primary or secondary procedure. Intracranial hypertension was defined as intracranial pressure (ICP) > 15 mm Hg on invasive monitoring 10,19 and/or presence of papilledema on fundoscopy 19 as diagnosed by a pediatric ophthalmologist (V.L.) in the absence of hydrocephalus.…”

Section: Methodsmentioning

confidence: 99%

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A proposal for a new classification of complications in craniosynostosis surgery

Shastin¹,

Peacock²,

Guruswamy

et al. 2017

PED

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OBJECTIVEComplications have been used extensively to facilitate evaluation of craniosynostosis practice. However, description of complications tends to be nonstandardized, making comparison difficult. The authors propose a new pragmatic classification of complications that relies on prospective data collection, is geared to capture significant morbidity as well as any “near misses” in a systematic fashion, and can be used as a quality improvement tool.METHODSData on complications for all patients undergoing surgery for nonsyndromic craniosynostosis between 2010 and 2015 were collected from a prospective craniofacial audit database maintained at the authors' institution. Information on comorbidities, details of surgery, and follow-up was extracted from medical records, anesthetic and operation charts, and electronic databases. Complications were defined as any unexpected event that resulted or could have resulted in a temporary or permanent damage to the child.RESULTSA total of 108 operations for the treatment of nonsyndromic craniosynostosis were performed in 103 patients during the 5-year study period. Complications were divided into 6 types: 0) perioperative occurrences; 1) inpatient complications; 2) outpatient complications not requiring readmission; 3) complications requiring readmission; 4) unexpected long-term deficit; and 5) mortality. These types were further subdivided according to the length of stay and time after discharge. The overall complication rate was found to be 35.9%.CONCLUSIONSThe proportion of children with some sort of complication using the proposed definition was much higher than commonly reported, predominantly due to the inclusion of problems often dismissed as minor. The authors believe that these complications should be included in determining complication rates, as they will cause distress to families and may point to potential areas for improving a surgical service.

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Section: Methodsmentioning

confidence: 99%

“…in the absence of hydrocephalus. 19 Standard anesthetic practice involved an inhalational agent, remifentanil infusion, and adjunctive analgesia, as well as clonidine where needed. Scalp nerve blocks were used in most cases to reduce intraoperative bleeding and decrease the need for systemic opioids.…”

Section: Methodsmentioning

confidence: 99%

A proposal for a new classification of complications in craniosynostosis surgery

Shastin¹,

Peacock²,

Guruswamy

et al. 2017

PED

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“…Due to the complexity of children with Apert syndrome and children with other forms of complex craniosynostoses, this approach has also been recommended for clinical management. This is due to the nature of the syndromes and the impact of "third variables" such as visual impairments, hearing impairments, low expectations, and teasing (Hayward et al, 2016). In order to understand each individual child's situation a case study approach was adopted.…”

Section: Methodsmentioning

confidence: 99%

Fingers Matter: The Development of Strategies for Solving Arithmetic Problems in Children With Apert Syndrome

Hilton

2019

Front. Educ.

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There is very little research on cognitive outcomes and challenges for children with Apert syndrome. This paper describes the findings of a 2½-year longitudinal exploration of the development of arithmetic skills in 10 children with Apert syndrome, who were aged between 4 and 9 years at the beginning of the study. There is evidence to suggest that children with Apert syndrome underachieve in mathematics, especially in areas requiring competence and confidence arithmetic. This study explored the changing strategies the children used as they developed their arithmetic problem solving skills. Of particular interest were the roles of finger gnosis and finger mobility in supporting the development of these skills. A case study approach was adopted in order to explore the children's problem solving strategies in depth. Children with Apert syndrome are born with their fingers fused and undergo several operations with the aim of ensuring that they have as many functioning fingers as possible. Finger gnosis and finger mobility were both seen to support arithmetic problem solving strategies and skills and reduce the reliance on mental strategies alone. This study found that children with Apert syndrome are disadvantaged if they are not supported to develop their finger gnosis and finger mobility skills. The findings have implications for children with Apert syndrome, but also add to the literature on the role of finger gnosis and finger mobility in the development of skills in early number and arithmetic.

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“…This policy is still adopted by many clinicians worldwide. 8 When surgical treatment is delayed, the sequelae of raised ICP increase in severity. However, many children may not be at risk of raised ICP and hence undergo unnecessary surgery carrying signi cant complication rates.…”

Section: Treatmentmentioning

confidence: 99%

Detection of Raised Intracranial Pressure in Craniosynostosis using Optical Coherence Tomography: A Systematic Review Protocol

Rufai

Jeelani

McLean

2020

Preprint

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Introduction Craniosynostosis is characterised by the premature fusion of cranial sutures. This can be associated with raised intracranial pressure (ICP), which can lead to developmental delay, visual impairment and death. Treatment involves surgical expansion of the skull vault. There is no consensus over who to treat and when. Intracranial pressure is difficult to estimate in a child and existing methods possess sub-optimal diagnostic accuracy to be employed as screening tools. Here, we propose a systematic review protocol to examine the role of optical coherence tomography (OCT) in early detection of raised ICP in craniosynostosis. Methods Electronic searches in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase will identify studies featuring OCT in detecting raised ICP in children with craniosynostosis. Two independent researchers will identify studies for inclusion using a screening questionnaire. Quality will be assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome measure is the sensitivity and specificity of OCT in detecting raised ICP in children with craniosynostosis. Secondary outcomes measures include the sensitivity and specificity of other surrogate measures for raised ICP, OCT parameters used and normal ranges for ICP reported. A formal narrative synthesis with descriptive statistics will be presented. Discussion The proposed study will be the first to examine the role of optical coherence tomography in the early recognition of raised intracranial pressure in craniosynostosis, thereby addressing an important clinical problem in paediatric ophthalmology and craniofacial surgery. This systematic review protocol provides transparency to the proposed methods and reduces the possibility of duplication. The proposed methods reflect those prescribed by the Cochrane Collaboration. Systematic review registration International Prospective Register for Systematic Reviews (PROSPERO) number CRD42019147693

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Connecting raised intracranial pressure and cognitive delay in craniosynostosis: many assumptions, little evidence

Cited by 36 publications

References 81 publications

A proposal for a new classification of complications in craniosynostosis surgery

A proposal for a new classification of complications in craniosynostosis surgery

Fingers Matter: The Development of Strategies for Solving Arithmetic Problems in Children With Apert Syndrome

Detection of Raised Intracranial Pressure in Craniosynostosis using Optical Coherence Tomography: A Systematic Review Protocol

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