Intracranial pressure in craniostenosis

Abstract

In this study, intracranial pressure (ICP) was recorded with an epidural sensor for periods of 12 to 24 hours in 92 cases of craniosynostosis. Pre- and postoperative recordings were performed in 23 patients, and 55 children underwent preoperative psychometric testing. The ICP was found to be normal in one-third of the cases, was obviously elevated in one-third, and was borderline in one-third. Waves of increased ICP were recorded during rapid eye movement (REM) sleep. After surgery, ICP decreased progressively and returned to normal in several weeks. A significant statistical relationship was found between the patients' ICP and their mental level: the higher the ICP the lower the mental level. The regression curve of ICP as a function of age shows that ICP is maximal at the age of 6 years and decreases later. The significance of these results is discussed. The authors recommend that ICP be recorded in cases of craniosynostosis since it is of some help in deciding whether patients should undergo surgery.

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

“…Our use of a threshold of more than 15 mm Hg to define an abnormally elevated ICP is consistent with that used by all previous studies that have undertaken overnight intracranial ICP monitoring in craniosynostosis, no matter whether an extradural or subdural device was employed. 6,11,13,28,35,42,43,45,46 The pathological significance of multiple B-type waves is also well recognized in the literature. 11,35,50 Consistent with the patient series of van Veelan et al and Cetas et al, we found that elevated ICP was diagnosed late, at least 2 years after primary surgery, with a mean at just under 4.5 years of follow-up.…”

“…6,11,13,28,35,42,43,45,46 The pathological significance of multiple B-type waves is also well recognized in the literature. 11,35,50 Consistent with the patient series of van Veelan et al and Cetas et al, we found that elevated ICP was diagnosed late, at least 2 years after primary surgery, with a mean at just under 4.5 years of follow-up. 8,47 This interval, along with the findings that only 1 patient had papilledema and that 4 children developed raised ICP on re-monitoring after a proven normal ICP, strongly suggests that the pathological rise in ICP we observed occurred after primary surgery.…”

Intellectual and Academic Functioning of School-Age Children With Single-Suture Craniosynostosis

“…Neurodevelopmental impairment has long been suspected among children with SSC, because the prematurely fused suture is believed to constrain 3 or alter 4,5 brain structures and elevate intracranial pressure. 6,7 Early neurodevelopmental investigations were beset with methodological problems and inconclusive findings, 8,9 but in more recent and better-designed studies, infants and preschoolers with SSC have consistently scored lower, on average, than same-aged children with patent sutures. [10][11][12][13] In a large multisite study of children in the United States from infancy to 36 months, we observed children with SSC to score on average about 0.25 to 0.50 SD lower on standardized tests than a demographically matched control group.…”

The occipitofrontal circumference: reliable prediction of the intracranial volume in children with syndromic and complex craniosynostosis

“…5,12,13,15,18,21,24,25,29,30,32 Postoperatively, 35%-43% of patients still develop raised ICP. 12,13,15,18,25,29,30 Factors influencing ICP in these patients include craniocerebral disproportion (a condition in which the brain grows faster than the skull), hydrocephalus, venous hypertension, and obstructive sleep apnea syndrome. 8,11,14 During follow-up of the surgically treated patient, the occipitofrontal circumference (OFC) is used as a derivative of ICV to evaluate whether craniocerebral disproportion might be present.…”