Subdural intracranial pressure monitoring in craniosynostosis: its role in surgical management

Thompson, Dominic; Harkness, William; Jones, Barry M.; Gonsalez, Sonia; Andar, U.; Hayward, Richard

doi:10.1007/bf00301758

Cited by 158 publications

(118 citation statements)

References 21 publications

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“…This incidence is still greater than that observed in other series of nonoperated scaphocephalic patients. 4,6,22,40,41,49,50 This difference may be explained by either the greater age of our patients or the high proportion of mild and nonscaphocephalic patients in the group.…”

Section: Discussionmentioning

confidence: 82%

“…Furthermore, it is now recognized that raised intracranial pressure (ICP) occurs in this group of patients, with an estimated preoperative incidence between 4.5% and 24%. 6,22,40,41,49,50 Therefore, the treatment of possible preexisting raised ICP, or the prevention of future ICP, provides a clear functional indication for surgery, in addition to the need to correct the morphological deformity present in these children.…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 82%

mentioning

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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“…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%

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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“…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%

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

Abu-Sittah¹,

Jeelani

Dunaway³

et al. 2016

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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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Subdural intracranial pressure monitoring in craniosynostosis: its role in surgical management

Cited by 158 publications

References 21 publications

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

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

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

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

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