Sustained Raised Intracranial Pressure Implicated Only by Pattern Reversal Visual Evoked Potentials after Cranial Vault Expansion Surgery

Liasis, Alki; Thompson, Dorothy; Hayward, Richard; Nischal, Ken K.

doi:10.1159/000071318

Cited by 38 publications

(13 citation statements)

References 13 publications

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“…Further details are contained in our previous study of children with Apert syndrome. 19 Raised ICP was diagnosed clinically (singly or in combination) by the presence of such "first-line" indicators as papilledema and/or a tense and bulging fontanelle in infants (or craniectomy defects from previous surgery in older children); scan evidence of progressive ventriculomegaly; and deteriorating EDTs 16,17,32 supported by radiological evidence (as described by Tuite et al 35 ). In the early part of the study period, invasive ICP monitoring (ICPM) was routinely performed at presentation.…”

Section: Methodsmentioning

confidence: 99%

“…In the early part of the study period, invasive ICP monitoring (ICPM) was routinely performed at presentation. However, since the late 1990s, we have increasingly relied on deterioration in EDTs (in particular, pattern reversal visual evoked potentials) as an indirect measure of raised ICP, 16,17,33 reserving ICPM for quantitative confirmation when required. When performed, ICPM was continued for 48 hours and results were categorized according to the range proposed by Renier et al 23 (< 10 mm Hg, normal; 10-15 mm Hg, borderline; and > 15 mm Hg, raised), with the addition of plateau waves if they more than doubled the baseline measurement and were sustained for ≥ 20 minutes.…”

Section: Methodsmentioning

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: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Abu-Sittah¹,

Jeelani

Dunaway³

et al. 2016

PED

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“…Triggers for surgery in our department are (1) clinical-bulging fontanelle, headache, vomiting; (2) ophthalmologic-papilloedema, disc changes, deterioration in electrophysiological tests of vision; and (3) radiologicprogressive hydrocephalus, obliteration of basal cisterns, or progressive cerebellar tonsillar ectopia. We have previously described our protocols around management of IH in Crouzon and Apert [1,2,7,11]. The IH criteria was established by a clinician (GJ) who was not involved with the 3DR surface area analysis (AM and NRF).…”

Section: Definition Of Intracranial Hypertensionmentioning

confidence: 99%

“…This allows a quantitative measurement of the extent of bone thinning compared to the qualitative assessment available on plain radiography. Unlike many craniofacial units, our philosophy at Great Ormond Street Hospital has been not to perform prophylactic vault expansion surgery on syndromic craniosynostosis cases but rather wait until the child demonstrates evidence of IH on clinical, ophthalmic, electrophysiological, or direct measurement grounds [1,2,7,11]. Therefore, we have a cohort of patients in which we can compare extent of cranial lacunae to IH on an intention-totreat basis, to assess whether the more quantitative measure on 3DR CT is more or less useful than the qualitative assessment of copper beating on plain radiograph.…”

Section: Introductionmentioning

confidence: 99%

Lack of association of cranial lacunae with intracranial hypertension in children with Crouzon syndrome and Apert syndrome: a 3D morphometric quantitative analysis

et al. 2019

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Purpose Cranial lacunae (foci of attenuated calvarial bone) are CT equivalents of Bcopper beating^seen on plain skull radiographs in children with craniosynostosis. The qualitative presence of copper beating has not been found to be useful for the diagnosis of intracranial hypertension (IH) in these patients. 3D morphometric analysis (3DMA) allows a more systematic and quantitative assessment of calvarial attenuation. We used 3DMA to examine the relationship between cranial lacunae and IH in children with Crouzon and Apert syndromic craniosynostosis. Methods Patients were divided into IH and non-IH groups defined on an intention-to-treat basis. Pre-operative CT scans were converted into 3D skull models and processed to quantify lacunae as a percentage of calvarium surface area (LCP). This was done on individual bone and whole skull basis. Results Eighteen consecutive children with Crouzon's syndrome and 17 with Apert syndrome were identified. Median age at CT scan was 135 days (range 6-1778). Of the 35 children, 21 required surgery for IH at median age of 364 days (range 38-1710). Of these 21 children, 14 had lacunae with mean LCP of 3% (0-28%). Of the 14 non-IH children, 8 had lacunae with mean LCP of 2% (0-8%). LCP was not significantly different between IH and non-IH groups. Parietal bones were most likely to show lacunae (IH 14/21, non-IH 9/14), followed by occipital (IH 8/21, non-IH 3/14), and frontal (IH 6/21, non-IH 2/14). Conclusion Results suggest that cranial lacunae, measured using quantitative 3DMA, do not correlate with IH, in agreement with evidence from qualitative plain skull radiograph studies.

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“…In these circumstances a measure of visual function is essential to identify and monitor the effects of raised ICP. We have previously demonstrated that the pattern reversal visual evoked potential (pVEP) has been reported to be a sensitive tool to identify early visual dysfunction as a result of raised ICP in children with Cs [11]. …”

Section: Introductionmentioning

confidence: 99%

Adenoid-Tonsillectomy to Treat Visual Dysfunction in a Child with Craniosynostosis

et al. 2005

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We report a child with isolated saggital synostosis where a gradual deterioration of the P100 component of the pattern reversal visual evoked potential recorded during the day was associated with episodes of upper airway obstruction during sleep that correlated with periods of ICP spiking. Adenoid-tonsillectomy reversed this deterioration with coincident increase in SaO₂ and decreased sleep apnoea.

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Sustained Raised Intracranial Pressure Implicated Only by Pattern Reversal Visual Evoked Potentials after Cranial Vault Expansion Surgery

Cited by 38 publications

References 13 publications

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

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

Lack of association of cranial lacunae with intracranial hypertension in children with Crouzon syndrome and Apert syndrome: a 3D morphometric quantitative analysis

Adenoid-Tonsillectomy to Treat Visual Dysfunction in a Child with Craniosynostosis

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