The Beaten Copper Cranium: A Correlation between Intracranial Pressure, Cranial Radiographs, and Computed Tomographic Scans in Children with Craniosynostosis

Tuite, Gerald F.; Evanson, Jane; Chong, W.K.; Thompson, Dominic; Harkness, William; Jones, Barry M.; Hayward, Richard

doi:10.1097/00006123-199610000-00007

Cited by 122 publications

(97 citation statements)

References 33 publications

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“…46 Furthermore, the identification of 2 patients with abnormal ICP but no corresponding signs on CT underscores the point made by Tuite and colleagues that radiological signs are neither specific nor sensitive in this regard. 46 We therefore conclude that once raised ICP is suspected, only formal monitoring can determine for certain whether it is present. We prefer to perform direct monitoring of ICP using an intraparenchymal Codman microsensor.…”

Section: Discussionmentioning

confidence: 86%

“…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.…”

Section: Discussionmentioning

confidence: 96%

“…Likewise, although a beaten-copper appearance of the calvaria on radiological imaging has long been associated with raised ICP, it is common following surgery for SC, and increases in incidence with patient age. 4,46 Similarly, reduction of the extraaxial space on CT, manifesting as effacement of the sulci and loss of the subarachnoid space, is more common in children with raised ICP, but is also present in those with normal pressures. 46 Furthermore, the identification of 2 patients with abnormal ICP but no corresponding signs on CT underscores the point made by Tuite and colleagues that radiological signs are neither specific nor sensitive in this regard.…”

Section: Discussionmentioning

confidence: 99%

“…4,46 Similarly, reduction of the extraaxial space on CT, manifesting as effacement of the sulci and loss of the subarachnoid space, is more common in children with raised ICP, but is also present in those with normal pressures. 46 Furthermore, the identification of 2 patients with abnormal ICP but no corresponding signs on CT underscores the point made by Tuite and colleagues that radiological signs are neither specific nor sensitive in this regard. 46 We therefore conclude that once raised ICP is suspected, only formal monitoring can determine for certain whether it is present.…”

Section: Discussionmentioning

confidence: 99%

“…1,24,32,47 Because the clinical symptoms and signs and radiological findings typically associated with intracranial hypertension are not reliable indicators of its presence in craniosynostosis, it is probable that the true incidence of postoperative raised ICP in SC is underestimated. 11,45,46 It is also unclear as to whether the rates of postoperative intracranial hypertension reported in the literature are specific to the surgical procedure used or are dependent on other factors.…”

mentioning

confidence: 99%

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

Thomas

Johnson

Byren

et al. 2015

PED

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OBJECT Raised intracranial pressure (ICP) is recognized to occur in patients with nonsyndromic isolated sagittal craniosynostosis (SC) prior to surgery. However, the incidence of raised ICP following primary surgery is rarely reported and there appears to be a widely held assumption that corrective surgery for SC prevents the later development of intracranial hypertension. This study reports the incidence of postoperative raised ICP in a large cohort of patients with SC treated by 1 of 2 surgical procedures in a single craniofacial unit. METHODS A retrospective review was performed of all patients with SC who underwent either a modified strip craniectomy (MSC) or calvarial remodeling (CR) procedure under the care of the Oxford Craniofacial Unit between 1995 and 2010 and who were followed up for more than 2 years. The influence of patient age at surgery, year of surgery, sex, procedure type, and the presence of raised ICP preoperatively were analyzed. RESULTS Two hundred seventeen children had primary surgery for SC and were followed up for a mean of 86 months. The overall rate of raised ICP following surgery was 6.9%, occurring at a mean of 51 months after the primary surgical procedure. Raised ICP was significantly more common in those patients treated by MSC (13 of 89 patients, 14.6%) than CR (2 of 128 patients, 1.6%). Also, raised ICP was more common in patients under 1 year of age, the majority of whom were treated by MCS. No other factor was found to have a significant effect. CONCLUSIONS Postoperative raised ICP was found in more than 1 in 20 children treated for nonsyndromic SC in this series. It was significantly influenced by the primary surgical procedure and age at primary surgery. Careful long-term follow-up is essential if children who develop raised ICP following surgery are not to be overlooked.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Thomas

Johnson

Byren

et al. 2015

PED

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Priorities for public health research on craniosynostosis: Summary and recommendations from a Centers for Disease Control and Prevention‐sponsored meeting

Rasmussen

Yazdy

Frías

et al. 2007

American J of Med Genetics Pt A

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On June 8-9, 2006, the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention held a meeting entitled "Prioritizing a Public Health Research Agenda for Craniosynostosis". The meeting goals were to review current knowledge in the area, discuss research gaps, and identify future priorities for public health research. Participants with a broad range of expertise (including clinical and molecular genetics, cranial morphology, epidemiology, pediatrics, psychology, public health, and surgery) contributed to the development of the research agenda. Meeting participants were asked to consider public health significance and feasibility when identifying areas of priority for future public health research. Participants identified several priorities, including the need to better delineate the prevalence and phenotype of craniosynostosis (CS); to identify factors important in the causation of CS (including potentially modifiable environmental risk factors as well as genes involved in isolated CS and gene-gene and gene-environment interactions); and to better understand short- and long-term outcomes of CS (e.g., surgical, neurocognitive and neuropsychological outcomes, psychological adjustment, and social relationships) and issues related to clinical care that could affect those outcomes. The need for improved collaboration among clinical treatment centers and standardization of data collection to address these priorities was emphasized. These priorities will be used to guide future public health research on CS.

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Shape and volume of craniofacial cavities in intentional skull deformations

Khonsari

Frieß

Nysjö

et al. 2013

American J Phys Anthropol

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Intentional cranial deformations (ICD) have been observed worldwide but are especially prevalent in preColombian cultures. The purpose of this study was to assess the consequences of ICD on three cranial cavities (intracranial cavity, orbits, and maxillary sinuses) and on cranial vault thickness, in order to screen for morphological changes due to the external constraints exerted by the deformation device. We acquired CT-scans for 39 deformed and 19 control skulls. We studied the thickness of the skull vault using qualitative and quantitative methods. We computed the volumes of the orbits, of the maxillary sinuses, and of the intracranial cavity using haptic-aided semi-automatic segmentation. We finally defined 3D distances and angles within orbits and maxillary sinuses based on 27 anatomical landmarks and measured these features on the 58 skulls. Our results show specific bone thickness patterns in some types of ICD, with localized thinning in regions subjected to increased pressure and thickening in other regions. Our findings confirm that volumes of the cranial cavities are not affected by ICDs but that the shapes of the orbits and of the maxillary sinuses are modified in circumferential deformations. We conclude that ICDs can modify the shape of the cranial cavities and the thickness of their walls but conserve their volumes. These results provide new insights into the morphological effects associated with ICDs and call for similar investigations in subjects with deformational plagiocephalies and craniosynostoses.

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The Beaten Copper Cranium: A Correlation between Intracranial Pressure, Cranial Radiographs, and Computed Tomographic Scans in Children with Craniosynostosis

Cited by 122 publications

References 33 publications

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

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

Priorities for public health research on craniosynostosis: Summary and recommendations from a Centers for Disease Control and Prevention‐sponsored meeting

Shape and volume of craniofacial cavities in intentional skull deformations

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