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

Abstract

Purpose In this study, we analyzed the utility of intracranial pressure (ICP) monitoring intraoperatively for deciding height reduction and need for cerebrospinal fluid (CSF) diversion during cranial vault remodeling in children with multisutural craniosynostosis (CS). Methods This is a retrospective observational study of children who underwent surgery for CS and ICP monitoring during surgery. The ICP was monitored using an external ventricular drainage catheter. The ICP monitoring was continued during the entire procedure. Results A total of 28 (19 boys) children with the involvement of two or more sutures underwent ICP monitoring during surgery. The commonest pattern of suture involvement was bicoronal seen in 16 (57.1%) children followed by pancraniosynostoses in eight (28.6%) cases. The mean opening ICP was 23 mm Hg, which dropped to 10.9 mm Hg after craniotomy. The ICP increased transiently to 19.5 mm Hg after height reduction, and the mean ICP at closure was 16.2 mm Hg. The ICP recordings helped in undoing the height reduction in two children and ventriculoperitoneal shunt after surgery in two children. Conclusions Intraoperative monitoring of ICP helps in deciding the type of cranial vault remodeling and the need for CSF diversion after surgery.

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.…”

“…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.…”

“…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.…”

“…Twenty-two studies described the duration of ICP measurement used to determine the presence of ICH. 2,3,[5][6][7][8][9][10][11][12][13][14][15]22,24,77,[84][85][86][87]89,94 Ten studies used 24 hours of data, 3,[9][10][11][12][13][14][15]24,87 6 used overnight measurements, 2,[5][6][7][8]84 and 4 studies used 1 minute of ICP measurements during anesthesia providing the ICP waveform was stable. 21,22,85,86 Two studies used another duration: 1 study used while under anesthesia for the length of surgical procedures, 77 and 1 for 48 hours.…”

Intracranial pressure monitoring in craniosynostosis

“…ey found a remarkable reduction in 43 out of 45 patients. [11] e work from NIMHANS published here suggests further use by modifying the degree of reconstruction during the procedure [12] and reporting the conversion of ICP ventricular catheter to VP shunt in non-responsive patients. Maybe, further information on ventricular size or status of venous anatomy, etc., in these patients will help us decide on advising regular use of this procedure.…”