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Analysis of intracranial pressure waveform using a non-invasive method in individuals with craniosynostosis

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Abstract

Purpose

Craniosynostosis can lead to symptoms resulting from cranial compliance (CC) changes and intracranial hypertension (ICH), which may cause cognitive and visual impairment. Non-invasive methods have emerged, including a new device that captures and processes the intracranial pressure waveform (ICPw) by the skull’s oscillation. The present study evaluates ICPw obtained non-invasively (NIICPw) in patients with craniosynostosis.

Methods

This prospective, cross-sectional, and descriptive study was conducted at a single center. Patients diagnosed with craniosynostosis and who provided informed consent were included. A US Food and Drug Administration–approved mechanical extensometer device (Brain4Care Corp.) was used to obtain a NIICPw. An ophthalmologist did a point-of-care retinography to check the optic nerve papilla. The P2/P1 ratio and the morphology of the NIICPw were analyzed, as well as the retinography.

Results

Thirty-five patients were evaluated, and 42 registers were obtained because seven were assessed before and after the surgery. The two patients who presented papilledema had low CC (NIICPw shape Class 3 or 4). There was a significant association between NIICPw and papilledema.

Conclusion

The ratio P2/P1 and the NIICPw morphology provided by a non-invasive monitor are related to CC changes before papilledema occurs. This is especially useful in patients with craniosynostosis because invasive ICP monitoring is not always feasible. Further studies are warranted to establish the clinical utility of NIICPw in patients with craniosynostosis.

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Authors and Affiliations

  1. Hospital of Rehabilitation of Craniofacial Anomalies of the University of São Paulo, São Paulo, Bauru, Brazil

    Michele Madeira Brandao, Cristiano Tonello, Isabella Parizotto, Luciano Brandao Machado & Nivaldo Alonso

Authors
  1. Michele Madeira Brandao
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  2. Cristiano Tonello
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  3. Isabella Parizotto
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  4. Luciano Brandao Machado
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  5. Nivaldo Alonso
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Contributions

Michele Brandao is the lead researcher and this study is part of her doctoral degree. She evaluated all patients. Cristiano Tonello is the craniofacial surgeon who operated on the patients. Aldo Igr is the co-advisor of this research. Isabella Parizotto is the ophthalmologist who performed retinography on all patients and provided the optic nerve classification. Luciano Brandao is the anesthesiologist who administered anesthesia to the patients in this study and developed the anesthesia protocol. Nivaldo Alonso is the senior professor, department chair, and the study's advisor.

Corresponding author

Correspondence to Michele Madeira Brandao.

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Brandao, M.M., Tonello, C., Parizotto, I. et al. Analysis of intracranial pressure waveform using a non-invasive method in individuals with craniosynostosis. Childs Nerv Syst 40, 145–152 (2024). https://doi.org/10.1007/s00381-023-06092-y

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  • DOI: https://doi.org/10.1007/s00381-023-06092-y

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