Child's Nervous System

, Volume 20, Issue 10, pp 749–756 | Cite as

Mild trigonocephaly and intracranial pressure: report of 56 patients

Original Paper



We report the surgical results in patients with mild trigonocephaly and clinical symptoms. Since high intracranial pressure (ICP) was noted during surgery in our previous patient series, we began to record intraoperative ICP. The importance of treating mild trigonocephaly with clinical symptoms is stressed.

Patients and methods

Fifty-six children (44 boys, 12 girls) in whom ICP was measured were diagnosed with mild trigonocephaly (nonsyndromic type) with symptoms such as language delay, hyperactivity, autistic tendencies, self-mutilation, motor delay, etc. Their ages ranged from 2 to 8 (mean 5.1) years. ICP was measured after a burr hole was made under endotracheal general anesthesia and a sensor was inserted in the right frontal lobe epidurally immediately in front of the right coronal suture. The first recordings were made at around 30 mmHg of PCO2 as for neuroanesthesia, and the second were at around 40 mmHg of PCO2 as during natural breathing. We also investigated which factors accounted for the improvement of clinical symptoms.


The first ICP records at 29.1 mmHg of PCO2 indicated a mean ICP of 13.3 mmHg. The second changed to a mean 38.2 mmHg of PCO2 for an increased mean ICP of 19.8 mmHg. The pulse pressures were a mean 7.1 mmHg in the first recordings and 8.5 mmHg in the second. The mean ICP and pulse pressure were thus high in these children. Clinically, 30 out of 56 patients improved markedly and 22 improved slightly, while 4 did not exhibit any change. Factors contributing to improvement were younger age, relatively higher development quotient, marked digital impressions on skull X-rays, abnormal findings on SPECT, and moderate degree of trigonocephaly.


Although our patients had mild trigonocephaly, their ICP and pulse pressure were high. Decompressive cranioplasty in cases of mild trigonocephaly is feasible.


Trigonocephaly Intracranial pressure Developmental delay Decompressive cranioplasty 


  1. 1.
    Arnoud E, Renier D, Marchac D (1995) Prognosis for mental function in scaphocephaly. J Neurosurg 83:476–479PubMedGoogle Scholar
  2. 2.
    Artru AA, Lam AM, Johnson JO, Sperry RJ (1997) Intracranial pressure, middle cerebral artery flow velocity, and plasma inorganic fluoride concentrations in neurosurgical patients receiving sevoflurane or isoflurane. Anesth Analg 85:587–592PubMedGoogle Scholar
  3. 3.
    Botterro L, Lajeunie E, Arnard E, Marchac D, Renier D (1998) Functional outcome after surgery for trigonocephaly. Plast Reconstr Surg 102:952–958PubMedGoogle Scholar
  4. 4.
    Cohen SR, Dauser RC, Newman MH, Murazko K (1993) Technical strategies. Surgical techniques of cranial vault expansion for increases in intracranial pressure in older children. J Craniofacial Surg 4:167–176Google Scholar
  5. 5.
    Collmann H, Sörenson N, Krauss J (1996) Consensus on trigonocephaly. Childs Nerv Syst 12:664–668PubMedGoogle Scholar
  6. 6.
    Di Rocco C, Ianelli A, Velardi F (1980) Early diagnosis and surgical indication in craniosynostosis. Childs Brain 6:175–188PubMedGoogle Scholar
  7. 7.
    Eide PK, Due-Tønnessen B, Helseth E, Lundar T (2001) Assessment of intracranial pressure volume relationships in childhood: the lumbar infusion test versus intracranial pressure monitoring. Childs Nerv Syst 17:382–390CrossRefPubMedGoogle Scholar
  8. 8.
    Foltz EL, Blanks JP, Yonemura K (1990) CSF pulsatility in hydrocephalus: respiratory effect on pulse wave slope as an indicator of intracranial compliance. Neurol Res 12:67–74PubMedGoogle Scholar
  9. 9.
    Harmer J, Alverti E, Hoyer S, Wiedemann K (1977) Influence of systemic and cerebral vascular factors on the cerebrospinal fluid pulse waves. J Neurosurg 46:36–45PubMedGoogle Scholar
  10. 10.
    Kapp-Simon KA (1998) Mental development and learning disorders in children with single suture craniosynostosis. Cleft Palate Craniofacial J 35:197–203Google Scholar
  11. 11.
    Karwacki Z, Kowianski P, Morys J, Dziewiatkowski J, Kaczmarek E, Suchorzewska J (2001) Effect of sevoflurane on intracranial pressure and cardiovascular function in rabbits with experimental intracerebral haematoma. Med Sci Monit 7:212–217Google Scholar
  12. 12.
    Marchac D, Renier D (1987) Treatment of craniosynostosis. Clin Plast Surg 14:61–72PubMedGoogle Scholar
  13. 13.
    Marmarou A, Shulman K, LaMorgese J (1975) Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43:523–534PubMedGoogle Scholar
  14. 14.
    Martínez-Lage JF, Alamo L, Poza M (1999) Raised intracranial pressure in minimal forms of craniosynostosis. Childs Nerv Syst 15:11–16CrossRefPubMedGoogle Scholar
  15. 15.
    Newton RW (1987) Intracranial pressure and its monitoring in childhood: a review. J R Soc Med 80:566–570PubMedGoogle Scholar
  16. 16.
    Oi S, Matsumoto S (1987) Trigonocephaly (metopic synostosis). Clinical, surgical and anatomical concepts. Childs Nerv Syst 3:259–265PubMedGoogle Scholar
  17. 17.
    Renier D (1989) Intracranial pressure in craniosynostosis: pre- and postoperative recordings—correlation with functional results. In: Persing JA, Edgerton MT, Jane JA (eds) Scientific foundations and surgical treatment of craniosynostosis. Williams & Wilkins, Baltimore, pp 263–269Google Scholar
  18. 18.
    Renier D, Sainte-Rose C, Marchac D, Hirsch JF (1982) Intracranial pressure in craniosynostosis. J Neurosurg 57:370–377PubMedGoogle Scholar
  19. 19.
    Shimoji T, Shimabukuro S, Sugama S, Ochiai Y (2002) Mild trigonocephaly with clinical symptoms: analysis of surgical results in 65 patients. Childs Nerv Syst 18:215–224CrossRefPubMedGoogle Scholar
  20. 20.
    Sidoti EJ Jr, Marsh JF, Marty-Grames L, Noetzel MJ (1996) Long-term studies of metopic synostosis: frequency of cognitive impairment and behavioral disturbances. Plast Reconstr Surg 97:276–281PubMedGoogle Scholar
  21. 21.
    Stavrou P, Sgouros S, Willshaw HE, Goldin JH, Hockley AD, Wake MJC (1997) Visual failure caused by raised intracranial pressure in craniosynostosis. Childs Nerv Syst 13:64–67CrossRefPubMedGoogle Scholar
  22. 22.
    Thompson DNP, Harkness W, Jones B, Gonsalez S, Andar U, Hayward R (1995) Subdural intracranial pressure in craniosynostosis: its role in surgical management. Childs Nerv Syst 11:269–275PubMedGoogle Scholar
  23. 23.
    Thompson DNP, Malcolm GP, Jones BM, Harkness WJ, Hayward RD (1995) Intracranial pressure in single-suture craniosynostosis. Pediatr Neurosurg 22:235–240PubMedGoogle Scholar
  24. 24.
    Tuite GF, Evanson J, Chong WK, Thompson DNP, Harkness WF, Jones B, Hayward RD (1996) The beaten copper cranium: a correlation between intracranial pressure, cranial radiographs, and computed tomographic scans in children with craniosynostosis. Neurosurgery 39:691–699PubMedGoogle Scholar
  25. 25.
    Whittle IR, Johnston IH, Besser M (1984) Intracranial pressure changes in craniosynostosis. Surg Neurol 21:367–372CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Department of NeurosurgeryOkinawa Prefectural Naha HospitalNaha CityJapan

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