Intracranial volume change in craniosynostosis

Sgouros, Spyros; Hockley, A. D.; Goldin, Judah; Wake, M.; Natarajan, K.

doi:10.3171/jns.1999.91.4.0617

Cited by 125 publications

(105 citation statements)

References 39 publications

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“…23 This assumption has been modified because 1) actual measurements of intracranial volume (ICV) have shown it is probably only of relevance for children who are < 1 year old 10,27,28 and/ or those whose skull growth rate declines following vault expansion surgery; 29 and 2) the role of VH has become appreciated, 14,25,31 particularly when associated with airway obstruction. 13 Although some of the children in this report were among those with previously ICPM-confirmed raised ICP in whom digital subtraction angiography had demonstrated obstructed intracranial venous drainage, 31 the diagnosis of VH was largely one of exclusion supported by clinical and scan evidence of prominent venous collateral channels.…”

Section: Craniocerebral Disproportion/venous Hypertensionmentioning

confidence: 99%

“…23 The causes of raised ICP are multiple. Although once attributed to craniocerebral disproportion (CCD), 23 this has largely been discounted since the measurement of intracranial volume became available 10,11,27 (except for patients under the age of 1 year 28 and those whose skull growth rate declines following vault expansion surgery 29 ) in favor of (often in combination) hydrocephalus, 7 airway obstruction, 13 and intracranial venous hypertension (VH). Because not all patients with CS (and other craniosynostosis-associated syndromes) develop raised ICP and because not all who do require cranial surgery for its management, the practice in our center has been to monitor children closely for evidence of elevated ICP and treat its particular cause(s) only after it has been detected.…”

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confidence: 99%

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Raised intracranial pressure in Crouzon syndrome: incidence, causes, and management

Abu-Sittah¹,

Jeelani

Dunaway³

et al. 2016

PED

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OBJECT Patients with Crouzon syndrome (CS) are at risk for developing raised intracranial pressure (ICP), which has the potential to impair both vision and neurocognitive development. For this reason, some experts recommend early prophylactic cranial vault expansion on the basis that if ICP is not currently raised, it is likely to become so. The aim of this study was to examine the justification for such a policy. This was done by analyzing the incidence, causes, and subsequent risk of recurrence in a series of patients with CS, in whom raised ICP was treated only after it had been diagnosed. METHODS This study was a retrospective review of the medical records and imaging data of patients with a clinical diagnosis of CS. RESULTS There were 49 patients in the study, of whom 30 (61.2%) developed at least 1 episode of raised ICP. First episodes occurred at an average age of 1.42 years and were attributable to craniocerebral disproportion/venous hypertension (19 patients), hydrocephalus (8 patients), and airway obstruction (3 patients). They were managed, respectively, by vault expansion, ventriculoperitoneal shunt insertion, and airway improvement. Fourteen of the 30 patients developed a second episode of raised ICP an average of 1.42 years after treatment for their initial episode, and 3 patients developed a third episode an average of 3.15 years after that. Causes of subsequent episodes of raised ICP often differed from previous episodes and required different management. Patients who were < 1 year old when the first episode was diagnosed were at increased risk of recurrence. CONCLUSIONS Although the incidence of raised ICP in CS is high, it did not occur in nearly 40% of children during the course of this study. The several possible causes of CS require different management and may vary from episode to episode. The authors recommend an expectant policy toward these children with careful clinical, ophthalmological, respiratory, and radiological monitoring for raised ICP, reserving intervention for when it has been detected and the appropriate treatment can be initiated.

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Section: Craniocerebral Disproportion/venous Hypertensionmentioning

confidence: 99%

mentioning

confidence: 99%

Raised intracranial pressure in Crouzon syndrome: incidence, causes, and management

Abu-Sittah¹,

Jeelani

Dunaway³

et al. 2016

PED

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“…The helmet is worn at least 23 hours per day until the patient is 1 year old, when 65% of the brain's growth has occurred. 23 During this 1st year following surgery, 2-4 orthotic helmets are required to account for changes in cranial shape and size.…”

Section: Helmet Protocolmentioning

confidence: 99%

One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

Nguyen

Farber

Skolnick

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEEndoscope-assisted repair of sagittal craniosynostosis was adopted at St. Louis Children’s Hospital in 2006. This study examines the first 100 cases and reviews the outcomes and evolution of patient care protocols at our institution.METHODSThe authors performed a retrospective chart review of the first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006 and 2014. The data associated with length of hospital stay, blood loss, transfusion rates, operative times, cephalic indices (CIs), complications, and cranial remolding orthosis were reviewed. Measurements were taken from available preoperative and 1-year postoperative 3D reconstructed CT scans.RESULTSThe patients’ mean age at surgery was 3.3 ± 1.1 months. Of the 100 patients, 30 were female and 70 were male. The following perioperative data were noted. The mean operative time (± SD) was 77.1 ± 22.2 minutes, the mean estimated blood loss was 34.0 ± 34.8 ml, and the mean length of stay was 1.1 ± 0.4 days; 9% of patients required transfusions; and the mean pre- and postoperative CI values were 69.1 ± 3.8 and 77.7 ± 4.2, respectively. Conversion to open technique was required in 1 case due to presence of a large emissary vein that was difficult to control endoscopically. The mean duration of helmet therapy was 8.0 ± 2.9 months. Parietal osteotomies were eventually excluded from the procedure.CONCLUSIONSThe clinical outcomes and improvements in CI seen in our population are similar to those seen at other high-volume centers. Since the inception of endoscope-assisted repair at our institution, the patient care protocol has undergone several significant changes. We have been able to remove less cranium using our “narrow-vertex” suturectomy technique without affecting patient safety or outcome. Patient compliance with helmet therapy and collaborative care with the orthotists remain the most essential aspects of a successful outcome.

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“…Contributors to an elevated baseline in craniosynostosis include, in the absence of hydrocephalus, craniocerebral disproportion (particularly for those younger than 1 year 24,63 ) and chronic venous hypertension (with or without an obstructed airway). 23,30,57,59 Studies that quote mean baseline levels 20,56,75 report pressures that rarely rise above 20 mm Hg-the level below which pediatric intensivists aim to keep their head-injured patients' ICP.…”

Section: Autoregulationmentioning

confidence: 99%

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

Hayward¹,

Britto

Dunaway

et al. 2016

PED

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Intracranial volume change in craniosynostosis

Cited by 125 publications

References 39 publications

Raised intracranial pressure in Crouzon syndrome: incidence, causes, and management

Raised intracranial pressure in Crouzon syndrome: incidence, causes, and management

One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

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

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