Abstract
Introduction
One third of patients with craniofacial dysostosis syndromes and about 15–20% of children with single suture craniostenosis have a documented increase in intracranial pressure (ICP). The early detection of intracranial hypertension is important in order to reduce the risks for brain development and visual function. However, in children with craniosynostosis, the clinical manifestations of abnormally increased ICP are difficult to detect, as the majority of patients may have neither warning signs nor symptoms for a long period of time.
Review
Moreover, data from the literature suggest that neither fundoscopic nor radiological findings are necessarily related to intracranial pressure recordings in this type of pathology. In this context prolonged ICP monitoring seems actually to be the most valuable diagnostic tool. Extradural, subdural, and intraparenchymal devices have been used, and different softwares have been employed for PC storage and analysis of the data obtained. Most recent series consider mean ICP combined with plateaux waves as the most sensitive indicators in the final evaluation of the results.
Conclusions
The analysis of the literature demonstrates a significant difference in the prevalence of raised ICP preoperatively between non-syndromic and syndromic patients. Among the non-syndromic children, a direct relation between the number of sutures involved and raised ICP is documented. The analysis of plateaux waves seems to be particularly important in children with borderline mean ICP values. Persistent postoperative raised ICP has been described in 6–15% of patients with craniofacial dysostosis. It must be related to the multifactorial etiology of increased ICP in these patients, which includes cerebral venous congestion, upper airway obstruction, and hydrocephalus.
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References
Allen R (1983) Time series methods in the monitoring of intracranial pressure. II. Comparative study and initial assessment. J Biomed Eng 5:103–109
Caldarelli M, Di Rocco C, Rossi GF (1979) Lumbar subarachnoid infusion test in pediatric neurosurgery. Dev Med Child Neurol 21:71–82
Chadduck WM, Chadduck JB, Boop FA (1992) The subarachnoid spaces in craniosynostosis. Neurosurgery 30:867–871
Eide PK (2003) The relationship between intracranial pressure and size of cerebral ventricles assessed by computed tomography. Acta Neurochir 145:171–179
Eide PK, Fremming AD (2001) A new method and software for quantitative analysis of continuous intracranial pressure recordings. Acta Neurochir 143:1237–1247
Eide PK, Helseth E, Tonnessen BD, Triggve L (2002) Assessment of continuous intracranial pressure recordings in childhood craniosynostosis. Pediatr Neurosurg 37:310–320
Eide PK, Fremming AD (2003) A computer-based method for comparisons of continuous intracranial pressure recordings within individual cases. Acta Neurochir 145:351–358
Eide PK, Helseth E, Due-Tonnessen B, Lundar T (2001) Changes in intracranial pressure after calvarial expansion surgery in children with slit ventricle syndrome. Pediatr Neurosurg 35:195–204
Gaab MR, Ungersbock K, Hufenbeck B (1986) Evaluation of ICP by computerized bedside monitoring. Neurol Res 8:44–52
Gambardella G, Zaccone C, Cardia E, Tomasello F (1993) Intracranial pressure monitoring in children: comparison of external ventricular device with the fiberoptic system. Childs Nerv Syst 9:470–473
Gault DT, Renier D, Marchac D, Jones BM (1992) Intracranial pressure and intracranial volume in children with craniosynostosis. Plast Reconstr Surg 90:377–381
Hassler W, Zentner J (1990) Radical osteoclastic craniectomy in sagittal synostosis. Neurosurgery 27:539–543
Jensen RL, Hahn YS, Ciro E (1997) Risk factors of intracranial pressure monitoring in children with fiberoptic devices: a critical review. Surg Neurol 47:16–22
Lemarie JJ, Boire JY, Chazal J, Irthum B (1994) A computer software for frequential analysis of slow intracranial pressure waves. Comput Methods Programs Biomed 42:1–14
Liasis A, Thompson DA, Hayward R, Nischal KK (2003) Sustained raised intracranial pressure indicated only by pattern reversal visual evoked potentials after cranial vault expansion surgery. Pediatr Neurosurg 39:75–80
Minns RA (1984) Intracranial pressure monitoring. Arch Dis Child 59:486–488
Morgalla MH, Cuno M, Mettenleiter H, Will BE, Krasznai L, Skalej M, Bitzer M, Grote EH (1997) ICP monitoring with a re-usable transducer: experimental and clinical evaluation of the Gaeltec ICT/b pressure probe. Acta Neurochir (Wien) 139:569–573
Morgalla MH, Stuum F, Hesse G (1999) A computer-based method for continuous single pulse analysis of intracranial pressure waves. J Neurol Sci 168:90–95
Munch E, Weigel R, Schmiedek P, Schurer L (1998) The Camino intracranial pressure device in clinical practice: reliability, handling characteristics and complications. Acta Neurochir (Wien) 140:1113–1120
Penson RP, Allen R (1998) Intracranial pressure monitoring by time domain analysis. J R Soc Health 118:289–294
Pople IK, Muhlbauer MS, Sanford RA, Kirk E (1995) Results and complications of intracranial pressure monitoring in 303 children. Pediatr Neurosurg 23:64–67
Reid A, Marchbanks RJ, Bateman DE, Martin AM, Brightwell AP, Pickard JD (1989) Mean intracranial pressure monitoring by a non-invasive audiological technique: a pilot study. J Neurol Neurosurg Psychiatry 52:610–612
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 and Wilkins, Baltimore, pp 263–269
Renier D, Sainte-Rose C, Marchac D, Hirsch J (1982) Intracranial pressure in craniosynostosis. J Neurosurg 57:370–377
Siddiqi S, Posnick JC, Buncic R, Humphreys RP, Hoffman HJ, Drake JM, Rutka JT (1995) The detection and management of intracranial hypertension after initial suture release and decompression for craniofacial dysostosis syndromes. Neurosurgery 36:703–709
Taylor WJ, Hayward RD, Lasjaunias P, Britto JA, Thompson DNP, Jones BM, Evans RD (2001) Enigma of raised intracranial pressure in patients with complex craniosynostosis: the role of abnormal intracranial venous drainage. J Neurosurg 94:377–385
Thompson DNP, Harkness W, Jones B, Gonzalez S, Andar U, Hayward R (1995) Subdural intracranial pressure monitoring in craniosynostosis: its role in surgical management. Childs Nerv Syst 11:269–275
Thompson DNP, Malcolm GP, Jones BM, Harkness WJ, Hayward RD (1995) Intracranial pressure in single suture craniosynostosis. Pediatr Neurosurg 22:235–240
Thompson DNP, Harkness W, Jones BM, Hayward RD (1997) Aetiology of herniation of the hindbrain in craniosynostosis. An investigation incorporating intracranial pressure monitoring and magnetic resonance imaging. Pediatr Neurosurg 26:288–295
Thompson DNP, Jones BM, Harkness W, Gonzalez S, Hayward RD (1997) Consequences of cranial vault expansion surgery for craniosynostosis. Pediatr Neurosurg 26:296–303
Tuite GF, Chong WK, Evanson J, Narita A, Taylor D, Harkness W, Jones BM, Hayward RD (1996) The effectiveness of papilledema as an indicator of raised intracranial pressure in children with craniosynostosis. Neurosurgery 38:272–278
Tuite GF, Evanson J, Chong WK, Thompson D, Harkness WF, Jones BM, Hayward R (1996) The beaten copper cranium: a correlation between intracranial pressure, cranial radiographs and computed tomographic scans in children with craniosynostosis. Neurosurgery 39:691–699
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Tamburrini, G., Caldarelli, M., Massimi, L. et al. Intracranial pressure monitoring in children with single suture and complex craniosynostosis: a review. Childs Nerv Syst 21, 913–921 (2005). https://doi.org/10.1007/s00381-004-1117-x
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DOI: https://doi.org/10.1007/s00381-004-1117-x