Abstract
In the management of craniosynostosis subdural intracranial pressure (ICP) monitoring has proved a useful and safe means of identifying those children with raised ICP who are at risk from its long-term sequelae and who would benefit from early surgical intervention. Overnight subdural ICP recordings have been obtained in 136 unoperated cases of craniosynostosis. Fifteen patients were studied both before and after cranial vault remodelling procedures. ICP was raised (>15 mmHg) in 35%, borderline (10–15 mmHg) in 27% and normal (<10 mmHg) in 27% of cases. Raised ICP was present in 28/53 of the syndromic craniofacial dysostosis cases and in 20/83 non-syndromic craniosynostosis cases investigated (P<0.001). Raised mean ICP and periodic plateaux of sustained ICP during sleep were particularly associated with the syndromic cases. Of the 15 patients studied following cranial vault surgery, 9 showed a reduction in ICP, 3 were unchanged and 3 had higher ICP postoperatively. The results of ICP monitoring can contribute significantly to formulating a rational and staged surgical management plan incorporating the need to normalise ICP and correct the frequently severe functional and cosmetic consequences of these disorders.
Similar content being viewed by others
References
Artu F, Terrier A, Gibert I, Messaoudi K, Charlot M, Naous H, Jordan C (1992) Monitorage de la pression intracrânienne par capteur intraparenchyateux à fibres optic: aspects techniques et fiabilité clinique. Ann Fr Anesth Reanim 11:424–429
Barlow P, Mendelow D, Lawrence AE, Barlow M, Rowan JO (1985) Clinical evaluation of two methods of subdural pressure monitoring. J Neurosurg 63:578–582
Caldarelli M, Di Rocco C, Rossi GF (1979) Lumbar subarachnoid infusion test in paediatric neurosurgery. Dev Med Child Neurol 21:71–82
Chambers IR, Mendelow AD, Sinar EJ, Modha P (1990) A clinical evaluation of the Camino subdural screw and ventricular monitoring kits. Neurosurgery 26:421–423
Collman H, Sorensen N, Krauss J, Muhling J (1988) Hydrocephalus in craniosynostosis. Child's Nerv Syst 4:279–285
Di Rocco C, McLone D, Shimoji T, Raimondi A (1975) Continuous intraventricular cerebrospinal fluid pressure recording in hydrocephalic children during wakefulness and sleep. J Neurosurg 42:683–689
Di Rocco C, Ianelli A, Velardi F (1980) Early diagnosis and surgical indication in craniosynostosis. Ghild's Brain 6:175–188
Fishman MA, Hogan GR, Dodge PR (1971) The concurrence of hydrocephalus and craniosynostosis. J Neurosurg 34:621–629
Francis PM, Beals S, Rekate H, Pittman HW, Manwaring K, Reiff J (1992) Chronic tonsillar herniation and Crouzon's syndrome. Pediatr Neurosurg 18:202–206
Gault DT, Renier D, Marchac D, Jones BM (1992) Intracranial pressure and intracranial volume in children with craniosynostosis. Plast Reconstr Surg 90:377–381
Gobiet W, Strahl EW, Bock WJ, Grote W (1976) Direct measurement of ICP in cases of craniosynostosis as a diagnostic aid for operation. In: Beks JWF, Bosch DA, Brock N (eds) Intracranial pressure III. Springer, Berlin Heidelberg New York, pp 336–339
Golabi M, Edwards MSB, Ousterhout DK (1987) Craniosynostosis and hydrocephalus. Neurosurgery 21:63–67
Hayward R, Harkness W, Kendall B, Jones B (1992) Magnetic resonance imaging in the assessment of craniosynostosis. Scand J Plast Reconstr Hand Surg 26:293–299
Hirsch JF, Lacombe J, Barritault L, Pierre-Kahn A, Ngeh R, Rimbert JN, Zonaoini A, Mises J, Gabersek V (1979) Pression intracrânienne et volume sanguin cerebral chez le nourisson hydrócephale au cours du sommeil. Neurochirurgie 25:31–36
Marchac D, Renier D, Jones BM (1988) Experience with the “floating forehead”. Br J Plast Surg 41:1–15
Minns RA (1991) Infectious and parainfectious encephalopathies. In: Minns RA (ed) Problems of intracranial pressure in childhood. (Clinics in developmental medicine, nos 113–114) MacKeith, London, pp 170–282
Moss ML (1975) Functional anatomy of cranial synostosis. Child's Brain 1:22–33
Rahilly PM (1980) Effects of sleep state and feeding on cranial blood flow of the human neonate. Arch Dis Child 55:265–270
Renier D (1989) Intracranial pressure in craniosynostosis: pre- and postoperative recordings-correlation with functional results. In: Persing JA, Edgerton MT, Jane J (eds) Scientific foundations and surgical treatment of craniosynostosis. Williams & Wilkins, Baltimore, pp 263–269
Renier D, Sainte-Rose C, Marchac D, Hirsch J (1982) Intracranial pressure in craniosynostosis. J Neurosurg 57:370–377
Sainte-Rose C, LaCombe J, Pierre-Kahn A, Renier D, Hirsch J (1984) Intracranial venous hypertension: cause or consequence of hydrocephalus in infants. J Neurosurg 69:727–736
Tasker RC, Matthew DJ (1991) Cerebral intraparenchymal pressure monitoring in non-traumatic coma: clinical evaluation of a new fibre optic device. Neuropediatrics 22:47–49
Thompson D, Gonsalez S, Hayward R, Lane R, Mackersie A, Jones B (1993) The temporal relationship between changes in sleep state, intracranial pressure and upper airway obstruction in children with craniosynostosis. In: Oritz-Monasterio F (ed) Craniofacial surgery 5. Mexico
Van Effenterre R, Houteville JP, Philippon J, Horn Y-E (1976) Interêt de la mesure de la pression intracrânienne dans les crâniosténoses découvertes aprés l'âge d'un an. Neurochirurgie 22:59–67
Whittle IR, Johnston IH, Besser M (1984) Intracranial pressure changes in craniosynostosis. Surg Neurol 21:367–372
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Thompson, D.N.P., Harkness, W., Jones, B. et al. Subdural intracranial pressure monitoring in craniosynostosis: its role in surgical management. Child's Nerv Syst 11, 269–275 (1995). https://doi.org/10.1007/BF00301758
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00301758