Elevated intracranial pressure with craniosynostosis: a multivariate model of age, syndromic status, and number of involved cranial sutures

Abstract

OBJECTIVE Children with multiple prematurely fused cranial sutures and those undergoing surgical correction later in life appear to experience worse neurocognitive outcomes, but it is unclear whether higher intracranial pressure (ICP) is implicated in this process. The purpose of this study was to elucidate the effect of age at intervention and number of involved cranial sutures on ICP, as well as to assess which cranial suture closure may be more associated with elevated ICP. METHODS The prospective craniofacial database at the authors’ institution was queried for patients undergoing initial corrective surgery for craniosynostosis in whom intraoperative measurement of ICP was obtained prior to craniectomy. Age, involved sutures, and syndromic status were analyzed in the context of measured ICP by using multiple linear regression. RESULTS Fifty patients met the inclusion criteria. Age at procedure (p = 0.028, β = +0.060 mm Hg/month) and multiple-suture involvement (p = 0.010, β = +4.175 mm Hg if multisuture) were both significantly implicated in elevated ICP. The actual number of major sutures involved was significantly correlated to ICP (p = 0.001; β = +1.687 mm Hg/suture). Among patients with single-suture involvement, there was an overall significant difference of median ICP across the suture types (p = 0.008), with metopic having the lowest (12.5 mm Hg) and sagittal having the highest (16.0 mm Hg). Patients with multiple-suture involvement had significantly higher ICP (p = 0.003; 18.5 mm Hg). Patients with craniofacial syndromes were 79.3 times more likely to have multiple-suture involvement (p < 0.001). Corrective surgery for craniosynostosis demonstrated significant intraoperative reduction of elevated ICP (all p < 0.050). CONCLUSIONS Syndromic status, older age at intervention for craniosynostosis, and multiple premature fusion of cranial sutures were associated with significantly higher ICP.

Intraoperative Measurement of Intracranial Pressure During Cranial Vault Remodeling in Children with Craniosynostosis

“…Increasing age and multisutural involvement are associated with higher incidence of increased ICP. 17 As syndromic cases have multisutural involvement, we had a higher proportion of syndromic cases in our series. The ICP monitoring was found useful in our cases of bicoronal synostoses at the time of reducing the height of the vertex to correct the turret deformity.…”

The Paediatric Vault Score (PVS)—A Novel Scoring Tool for Prioritisation of Surgical Management of Craniosynostosis Patients

“…In addition, a recent article12 compared the long-term outcomes of syndromic and nonsyndromic craniosynostosis procedures and, even with its small cohort, found that repeat surgeries were more common in syndromic cases. Further, syndromic patients have a 79.3 times higher risk of multisuture involvement when compared with nonsyndromic patients13; hence the awards in this section.…”

What We Know About Intracranial Hypertension in Children With Syndromic Craniosynostosis

“…Of the 28 studies, 17 studies relied on invasive ICP measurements or LP alone to assess ICH. 2,3,[5][6][7][8]18,[20][21][22]24,77,[84][85][86][87]92 A further 11 studies also used indirect methods of ICH assessment in addition to the invasive ICP or LP measurement. [9][10][11][12][13][14][15][16][17]19,23 Twenty-five studies used ICP, 3,[5][6][7][8]18,21,22,24,77,[84][85][86][87]89,93 one study used LP, 18 and 2 used ICP and LP 16,23 to determine ICH.…”

“…Of the 25 studies using ICP, 21 reports both the duration and cut-off value. 2,3,[5][6][7][8][10][11][12][13][14][15]21,22,24,77,[84][85][86][87]89 Of the remaining 4, 1 reports duration but does not report cutoff value, 9 and 3 reports neither duration nor cut-off values used to determine ICH. 17,19,20 In the 3 LP measurement studies, 1 reported duration and cutoff value, 18 1 used the CSF opening pressure for LP measurement, reports cutoff value but not duration of ICP measurement, 16 and the last did not report duration or cutoff values for ICP and LP measurement.…”