Child's Nervous System

, Volume 30, Issue 8, pp 1367–1374 | Cite as

Cerebral oxygenation and hemodynamic measurements during craniosynostosis surgery with near-infrared spectroscopy

  • M. Martini
  • A. Röhrig
  • M. Wenghoefer
  • E. Schindler
  • A. M. Messing-Jünger
Original Paper



Focal pressure-related changes in brain perfusion and metabolism are discussed in single-suture craniosynostosis and brachycephalic cases (bicoronal synostosis). Raised intracranial pressure levels could be measured in some cases. In order to find possible loco-regional brain tissue changes during plastic surgery, we investigated oxygenation and perfusion parameters using non-invasive near-infrared spectroscopy (NIRS) probes.


Twenty-two consecutively operated cases (mean age 7 months) with single-suture craniosynostosis were prospectively investigated using a NIRS probe (LEA©, O2C, white light 500–800 nm, laser NIR). Measurements for oxygen saturation (SO2), relative quantity of hemoglobin (rHb), blood flow, and blood flow velocity of the bilateral frontal, temporal, and parietal cortices were taken transosseously (prior to decompression) and epidurally directly after decompression as well as 15 and 30 min after decompression and before closure.


Twenty-two patients with scaphocephaly (11), trigonocephaly (6), anterior plagiocephaly (3), and brachycephaly (2) were investigated. SO2 was improving in all patient subgroups, showing the highest levels in the fronto-temporal region; rHb improved in scaphocephalic, trigonocephalic, and brachycephalic children. Again, the highest values were found not only in the temporal but also in the frontal region and in brachycephalic patients also in the parietal cortex.


These preliminary results of a new technology for brain tissue oxygenation and blood flow measurements suggest a regional compromise of cortical metabolism and circulation in patients with craniosynostosis.


Craniosynostosis Brain oxygenation Cerebral perfusion Near-infrared spectroscopy (NIRS) 


Conflict of interest

The authors report no conflicts of interest related to the contents of this paper and declare to have no funding for the underlying study.


  1. 1.
    Ahmad R, Kuppusamy P (2010) Theory, instrumentation, and applications of electron paramagnetic resonance oximetry. Chem Rev 110:3212–3236PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Balan P, Kushnerenko E, Sahlin P, Huotilainen M, Naatanen R, Hukki J (2002) Auditory ERPs reveal brain dysfunction in infants with plagiocephaly. J Craniofac Surg 13:520–525PubMedCrossRefGoogle Scholar
  3. 3.
    Becker DB, Petersen JD, Kane AA, Cradock MM, Pilgram TK, Marsh JL (2005) Speech, cognitive, and behavioral outcomes in nonsyndromic craniosynostosis. Plast Reconstr Surg 116:400–407PubMedCrossRefGoogle Scholar
  4. 4.
    David LR, Wilson JA, Watson NE, Argenta LC (1996) Cerebral perfusion defects secondary to simple craniosynostosis. J Craniofac Surg 7:177–185PubMedCrossRefGoogle Scholar
  5. 5.
    Gault DT, Renier D, Marchac D, Jones BM (1992) Intracranial pressure and intracranial volume in children with craniosynostosis. Plast Reconstr Surg 90:377–381PubMedCrossRefGoogle Scholar
  6. 6.
    Hayward R (2005) Venous hypertension and craniosynostosis. Childs Nerv Syst 21:880–888PubMedCrossRefGoogle Scholar
  7. 7.
    Hirth C (1998) Nichtinvasives optisches Mapping und Spektroskopie zur Funktionellen Untersuchung des Gehirns – Räumliche, zeitliche und physiologische Aspekte lokaler Veränderungen der Blutoxygenierung bei funktioneller Aktivierung. Inaugural Dissertation, Klinik für Neurologie der Medizinischen Fakultät Charité, Humboldt-Universität, Berlin, Prof. KM EinhäuplGoogle Scholar
  8. 8.
    Hukki J, Saarinen P, Kangasniemi M (2008) Single suture craniosynostosis: diagnosis and imaging. Front Oral Biol 12:79–90PubMedCrossRefGoogle Scholar
  9. 9.
    Kreiborg S, Cohen MM Jr (1991) The infant Apert skull. Neurosurg Clin N Am 2:551–555PubMedGoogle Scholar
  10. 10.
    Marchac D, Renier D (1979) The “floating forehead”. Early treatment of craniofacial stenosis. Ann Chir Plast 24:121–126PubMedGoogle Scholar
  11. 11.
    Murkin JM, Arango M (2009) Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth 103(Suppl 1):i3–i13PubMedCrossRefGoogle Scholar
  12. 12.
    Newman SA (1991) Ophthalmic features of craniosynostosis. Neurosurg Clin N Am 2:587–610PubMedGoogle Scholar
  13. 13.
    Renier D, Lajeunie E, Arnaud E, Marchac D (2000) Management of craniosynostoses. Childs Nerv Syst 16:645–658PubMedCrossRefGoogle Scholar
  14. 14.
    Renier D, Sainte-Rose C, Marchac D, Hirsch JF (1982) Intracranial pressure in craniostenosis. J Neurosurg 57:370–377PubMedCrossRefGoogle Scholar
  15. 15.
    Soul JS, du Plessis AJ (1999) New technologies in pediatric neurology. Near-infrared spectroscopy. Semin Pediatr Neurol 6:101–110PubMedCrossRefGoogle Scholar
  16. 16.
    Speltz ML, Kapp-Simon KA, Cunningham M, Marsh J, Dawson G (2004) Single-suture craniosynostosis: a review of neurobehavioral research and theory. J Pediatr Psychol 29:651–668PubMedCrossRefGoogle Scholar
  17. 17.
    Taylor WJ, Hayward RD, Lasjaunias P, Britto JA, Thompson DN, Jones BM, Evans RD (2001) Enigma of raised intracranial pressure in patients with complex craniosynostosis: the role of abnormal intracranial venous drainage. J Neurosurg 94:377–385PubMedCrossRefGoogle Scholar
  18. 18.
    Thompson DN, Malcolm GP, Jones BM, Harkness WJ, Hayward RD (1995) Intracranial pressure in single-suture craniosynostosis. Pediatr Neurosurg 22:235–240PubMedCrossRefGoogle Scholar
  19. 19.
    Wan DC, Kwan MD, Lorenz HP, Longaker MT (2008) Current treatment of craniosynostosis and future therapeutic directions. Front Oral Biol 12:209–230PubMedCrossRefGoogle Scholar
  20. 20.
    Watzman HM, Kurth CD, Montenegro LM, Rome J, Steven JM, Nicolson SC (2000) Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology 93:947–953PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • M. Martini
    • 1
  • A. Röhrig
    • 2
  • M. Wenghoefer
    • 1
  • E. Schindler
    • 3
  • A. M. Messing-Jünger
    • 2
  1. 1.Klinik und Poliklinik für Mund-, Kiefer- und Plastische GesichtschirurgieUniversitätsklinik BonnBonnGermany
  2. 2.Abteilung für KinderneurochirurgieAsklepios Klinik Sankt AugustinSankt AugustinGermany
  3. 3.Zentrum für KinderanästhesiologieAsklepios Klinik Sankt AugustinSankt AugustinGermany

Personalised recommendations