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Craniofacial reconstruction as a treatment for elevated intracranial pressure

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Abstract

Introduction

Craniofacial procedures may be needed to address symptomatic intracranial hypertension. The authors review their institutional experience in the treatment of children with symptomatic increased intracranial pressure (ICP) utilizing craniofacial reconstructive procedures.

Methods

The senior authors’ (HSM, SRC) craniofacial experience of 222 patients over a 7-year period from 2000 to 2007 at a single institution (Rady Children’s Hospital, San Diego) is reviewed. Seventeen patients were identified who were felt to be candidates for craniofacial surgery with symptomatic increased ICP.

Results

Patient diagnoses included single-suture craniosynostosis, craniofacial dysostoses, shunt-induced craniostenosis, and shunt-associated intracranial hypertension (slit-ventricle syndrome). Seventeen patients underwent 21 craniofacial procedures. Age at surgery ranged from 3 months to 13 years with a mean of 5 years. Preoperative symptoms and signs included headaches, unexplained irritability, seizures, papilledema, and visual loss. All patients had diagnostic neuroimaging. Seven patients had preoperative invasive ICP measurements. Surgery was deferred on three of these patients based on these measurements. The mean total operative (including anesthetic preparation) and surgical times were 3 h 12 min and 2 h 20 min, respectively. Percentage operative blood loss averaged 11.3%. In six procedures, no transfusions were required. Average hospital stay was 4 days. There was no perioperative mortality or significant surgery associated morbidity. All patients have had postoperative clinical improvement in signs and symptoms of increased ICP.

Conclusions

Using modern diagnostic and surgical techniques, including invasive ICP monitoring, increased intracranial pressure can be successfully managed by an experienced, multidisciplinary, craniofacial team. Our treatment paradigm and operative management scheme is discussed.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Neurosurgery, University of California at San Diego, San Diego, CA, USA

    Lissa C. Baird, David Gonda, Michael L. Levy & Hal S. Meltzer

  2. Division of Craniofacial and Plastic Surgery, Rady Children’s Hospital, San Diego, CA, USA

    Steven R. Cohen & Lars H. Evers

  3. Division of Neurosurgery, Rady Children’s Hospital, 8010 Frost Street, Suite 502, San Diego, CA, 92123, USA

    Nathalie LeFloch, Michael L. Levy & Hal S. Meltzer

  4. Children’s Hospital Boston, 300 Longwood Ave, Boston, MA, 02215, USA

    Lissa C. Baird

Authors
  1. Lissa C. Baird
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  2. David Gonda
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  3. Steven R. Cohen
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  4. Lars H. Evers
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  5. Nathalie LeFloch
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  6. Michael L. Levy
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  7. Hal S. Meltzer
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Correspondence to Lissa C. Baird.

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Baird, L.C., Gonda, D., Cohen, S.R. et al. Craniofacial reconstruction as a treatment for elevated intracranial pressure. Childs Nerv Syst 28, 411–418 (2012). https://doi.org/10.1007/s00381-011-1615-6

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  • DOI: https://doi.org/10.1007/s00381-011-1615-6

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