Delayed intracranial hypertension after cranial vault remodeling for nonsyndromic single-suture synostosis

Cetas, Justin S.; Nasseri, Morad; Saedi, Targol; Kuang, Anna A.; Selden, Nathan R.

doi:10.3171/2013.3.peds12525

Cited by 35 publications

(52 citation statements)

References 29 publications

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“…In a smaller series of 47 patients with SC, Cetas and colleagues reported postoperative raised ICP in 5 patients (10.5%), 2 of whom had strip craniectomies with barrel staving and 3 an anterior two-thirds cranial vault reconstruction. 8 This rate more closely reflects that of this series. All of their patients presented with symptoms of raised ICP and 3 had papilledema.…”

Section: Discussionmentioning

confidence: 60%

“…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. 8,47 This interval, along with the findings that only 1 patient had papilledema and that 4 children developed raised ICP on re-monitoring after a proven normal ICP, strongly suggests that the pathological rise in ICP we observed occurred after primary surgery. We have no evidence to indicate that an elevated ICP was present beforehand and persisted through the first corrective procedure to the time of diagnosis after surgery in any patients in this study.…”

Section: Discussionmentioning

confidence: 91%

“…1,3,8 In our unit we do not perform serial radiological investigations in asymptomatic postoperative children, to minimize their radiation exposure. Therefore, we cannot comment as to whether early restenosis occurred in this series.…”

Section: Discussionmentioning

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: 60%

Section: Discussionmentioning

confidence: 91%

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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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“…13,28,45,47 However, it is difficult to infer anything directly from these observations without corresponding ICP data, because in the authors' and others' experience, raised ICP can occur after surgical corrective procedures. 9 Any resultant decline in neurocognitive function in affected individuals could mask an improvement in the overall group. Furthermore, there is contrary evidence that, after surgery, single-suture craniosynostosis patients are of normal intelligence during school-age years and patients with a proven raised preoperative ICP experience improved neurocognitive functioning.…”

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confidence: 99%

The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature

Wall¹,

Thomas²,

Johnson³

et al. 2014

PED

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Object The presence of raised intracranial pressure (ICP) in untreated nonsyndromic, isolated sagittal craniosynostosis (SC) is an important functional indication for surgery. Methods A retrospective review was performed of all 284 patients presenting with SC to the Oxford Craniofacial Unit between 1995 and 2010. Results Intraparenchymal ICP monitoring was performed in 39 children following a standard unit protocol. Monitoring of ICP was offered for all patients in whom nonoperative management was considered on the basis of minimal deformity or in cases in which parents were reluctant to agree to corrective surgery. These patients presented at an older age than the rest of the cohort (mean age 56 months), with marked scaphocephaly (16/39, 41%), mild scaphocephaly (11, 28%), or no scaphocephalic deformity (12, 31%). Raised ICP was found in 17 (44%) patients, with no significant difference in its incidence among the 3 different deformity types. Raised ICP was not predicted by the presence of symptoms of ICP or developmental delay or by ophthalmological or radiological findings. Conclusions The incidence of raised ICP in SC reported here is greater than that previously published in the literature. The lack of a reliable noninvasive method to identify individuals with elevated ICP in SC mandates consideration of intraparenchymal ICP monitoring in all patients for whom nonoperative management is contemplated.

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“…Seven studies 2,7,[16][17][18][19]30,33 met inclusion criteria for analy sis of the primary outcome: incidence of IH after surgery confirmed by invasive ICP monitoring (Table 1). Addi tional studies that used alternate methods of confirmation of IH were excluded from the analysis but are reviewed in the discussion and included 4 studies using lumbar punc ture as confirmation of IH; 1,6,14,23 1 study using the pres ence of papilledema; 4 and 2 studies used a combination of ICP monitoring, clinical symptoms, and the presence of papilledema 25,28 (Table 2).…”

Section: Results General Characteristicsmentioning

confidence: 99%

Intracranial hypertension after surgical correction for craniosynostosis: a systematic review

Christian¹,

Imahiyerobo

Nallapa³

et al. 2015

FOC

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OBJECT The authors’ aim was perform a systematic review on the incidence of intracranial hypertension (IH) after surgery for craniosynostosis. METHODS A systematic literature review was conducted using PubMed to assess the rate of postoperative IH in studies published between 1985 and 2014. Inclusion criteria were 1) English-language literature; 2) human subjects; 3) pediatric cases; and 4) postoperative IH confirmed with invasive intracranial pressure monitoring. RESULTS Seven studies met inclusion criteria. IH was reported to be present in 5% of patients postoperatively with sagittal synostosis and 4% of patients with all forms of nonsyndromic craniosynostosis. Inadequate numbers were available to determine the incidence of postoperative IH for syndromic and individual nonsyndromic sutural synostosis based on the inclusion criteria. Surgical groups were subdivided into cranial remodeling procedures without orbital advancement and craniofacial procedures with orbital advancement. IH was reported to be present in 5% of patients with all forms of nonsyndromic sutural stenosis after cranial remodeling procedures and 1% after craniofacial advancement. CONCLUSIONS Postoperative development of elevated intracranial pressure has been described by multiple institutions, but the variation in how IH is determined and the multiple surgical procedures to correct craniosynostosis has limited the number of studies subject to a meta-analysis. Nonetheless, this entity deserves special attention, and further studies are required to determine the true incidence of postoperative IH, including the role of various surgical procedures on its incidence. The long-term consequences of chronic IH in this group of patients also need to be evaluated.

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Delayed intracranial hypertension after cranial vault remodeling for nonsyndromic single-suture synostosis

Cited by 35 publications

References 29 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

The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature

Intracranial hypertension after surgical correction for craniosynostosis: a systematic review

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