The role of ICP overnight monitoring (ONM) in children with suspected craniostenosis

Zipfel, Julian; Jager, Beatrice; Collmann, H.; Czosnyka, Zofia; Schuhmann, Martín U.; Schweitzer, Tilmann

doi:10.1007/s00381-019-04288-9

Cited by 13 publications

(10 citation statements)

References 27 publications

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“…Controversy persists about headaches being caused by increased ICP in SSS patients [7]. Two series of intraoperative monitoring in SSS patient revealed elevated ICP values being 16.1±2.4 mmHg mainly in infants or higher than 20cm H 2 O in 82% of older patients [19,20] underlining the need for volume expansion.…”

Section: Discussionmentioning

confidence: 99%

Biparietal meander expansion technique for sagittal suture synostosis in patients older than 1 year of age—technical note

et al. 2021

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Objective Sagittal suture synostosis (SSS) is the most common form of craniosynostosis. For older patients, the strategy for surgical correction needs to consider diminished growth dynamics of the skull and an active reconstruction cranioplasty aims to sustain stability for the active child. We describe our technique of biparietal meander expansion (BME) technique for SSS for patients older than 1 year and retrospectively reviewed the perioperative course as well as the subjective experience of patients and caregivers during follow-up. Methods The BME technique incorporates bilateral serpentine craniotomies and fixation of the consecutively expanded bone tongues with crossing sutures for patients with SSS older than 12 months of age at surgery. We reviewed patients undergoing this surgical technique for correction of SSS and collected data about the clinical course and performed a patients reported outcome measure (PROM) for patients or caregivers to evaluate subjective experience and outcome after surgical treatment. Results BME was performed in 31 patients (8 females; median age: 43 months; range 13–388). The mean length of operation was 172.7±43 minutes (range 115–294). Patients experienced no immediate complications or neurological morbidity after surgery. Considering a total of 21 completed PROM questionnaires, the head shape after surgery was evaluated as either “better” (57%) or “much better” (43%) compared to preoperatively. Eighty-one percent of patients or caregivers answered that the patient experiences no limitation in daily activities. Although 42.8% perceived the hospital as strenuous, 90.5% would choose to undergo this treatment again. Conclusion BME is a feasible technique for older SSS patients resulting in immediate stability of the remodelled calvarium with a more normal head shape. The survey among caregivers or patients revealed a favourable subjectively experienced outcome after this type of surgical treatment of SSS in the more complex context of an older patient cohort.

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Section: Discussionmentioning

confidence: 99%

Biparietal meander expansion technique for sagittal suture synostosis in patients older than 1 year of age—technical note

et al. 2021

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“…The existence of a rather lower RAP in moderate-to-severe skull x-ray changes indicates that the reserve capacity is already exhausted and cerebrovascular integrity is affected by rising ICP and surgery should be performed rather earlier than later. [ 10 ]…”

Section: Methodsmentioning

confidence: 99%

“…e existence of a rather lower RAP in moderate-to-severe skull x-ray changes indicates that the reserve capacity is already exhausted and cerebrovascular integrity is affected by rising ICP and surgery should be performed rather earlier than later. [10] Intraoperative monitoring: is has prompted studies on intraoperative monitoring during reconstruction (Judy et al, J Neurosurg Ped, 2018).ey regulated end-tidal carbon dioxide and the monitoring site for subdural recordings under general anesthesia to record consistent ICP readings. ey found a remarkable reduction in 43 out of 45 patients.…”

Section: Journal Of Neurosciences In Rural Practicementioning

confidence: 99%

Intracranial pressure monitoring in craniosynostosis

Deopujari

Samantray

2022

JNRP

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“…Therefore, the appearance of diffuse fingerprinting might suggest ICH, although clinical decisions cannot be based solely on the presence of fingerprinting. In addition, Zifel et al [20] showed an association with the intracranial reserve capacity, indicating the reserve capacity is already exhausted in case of severe fingerprinting on skull X-rays. To minimize false-positive results in our study, we only included patients with severe diffuse fingerprinting.…”

Section: Clinical Impactmentioning

confidence: 99%

“…Fingerprinting can be a sign of ICH [17][18][19][20]. For this study, postoperative skull radiographs within 1 year of the OCT scan were included.…”

Section: Sagittal Synostosis -Fingerprintingmentioning

confidence: 99%

The use of OCT to detect signs of intracranial hypertension in patients with sagittal suture synostosis: Reference values and correlations

et al. 2022

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Purpose To obtain pediatric normative reference values and determine whether optical coherence tomography (OCT) corresponds better with clinical signs of intracranial hypertension (ICH) compared to the traditional screening method fundoscopy in a large cohort of one type of single suture craniosynostosis. Methods Control subjects without optic nerve diseases and isolated sagittal synostosis patients aged 3–10 years who underwent fundoscopy and OCT were included in this prospective cohort study. Normative reference values were obtained through bootstrap analysis. Main outcome was the association between peripapillary total retinal thickness (TRT) and total retinal volume (TRV) and appearance on fundoscopy. Signs and symptoms suggestive of ICH, including skull growth arrest, fingerprinting, and headache, were scored. Results Sixty-four healthy controls and 93 isolated sagittal synostosis patients were included. Normative cut-off values for mean TRT are < 256 μm and > 504 μm and for mean TRV < 0.21 mm3 and > 0.39 mm3. TRT was increased in 16 (17%) and TRV in 15 (16%) of 93 patients, compared to only 4 patients with papilledema on fundoscopy (4%). Both parameters were associated with papilledema on fundoscopy (OR = 16.7, p = 0.02, and OR = 18.2, p = 0.01). Skull growth arrest was significantly associated with abnormal OCT parameters (OR = 13.65, p < 0.01). Conclusions The established cut-off points can be applied to screen for ICH in pediatrics. The present study detected abnormalities with OCT more frequent than with fundoscopy, which were associated with skull growth arrest. Therefore, a combination of OCT, fundoscopy, and skull growth arrest can improve clinical decision-making in craniosynostosis.

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The role of ICP overnight monitoring (ONM) in children with suspected craniostenosis

Cited by 13 publications

References 27 publications

Biparietal meander expansion technique for sagittal suture synostosis in patients older than 1 year of age—technical note

Biparietal meander expansion technique for sagittal suture synostosis in patients older than 1 year of age—technical note

Intracranial pressure monitoring in craniosynostosis

The use of OCT to detect signs of intracranial hypertension in patients with sagittal suture synostosis: Reference values and correlations

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