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Intraoperative pre- and post-craniofacial reconstruction intracranial pressure (ICP) monitoring in children with craniosynostosis

Child's Nervous System volume 29, pages 1363–1367 (2013)Cite this article

Abstract

Introduction

One of the goals of cranial vault expansion performed in patients with craniosynostosis (CS) is to reduce the harmful effects associated with elevated intracranial pressure (ICP). Until now, clear guidelines on when cranial vault expansion should take place have not been established except in unacceptable cosmetic deformities.

Materials and methods

This paper illustrates the potential benefit of ICP monitoring in determining the time of surgery. The ICP of six patients (ranging from 7 months to 8 years) was measured before and after surgery. For the first time, we regulated end-tidal carbon dioxide, the position and movements, the level of sedation and the monitoring site of our patients under anesthesia to report accurate ICP readings.

Results

The mean pre- and postoperative ICPs were 14.7 and 4.2 mmHg, respectively. Pressure sensor was placed through a burr hole under general anesthesia and remained through all stages of recording. Though ICP monitoring has been reported before, the physiological fluctuations of ICP and patient’s condition affected results. Under our ICP monitoring protocol, the six-patient study represents a suggestion to standardize ICP measurements under certain conditions in order to improve the reproducibility of ICP monitoring and therefore establish the need for optimal timing of cranial vault expansion in pediatrics.

Conclusion

Although we cannot clearly define the indications and establish normal pediatric ICP values from the result of this study because of the small number of cases and some other limitations, this is a new approach to define ICP increase as a potential indication for surgery in CS.

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Acknowledgement

We thank Dr. Kostadin Karagiozov and David Huang for his guidance and gratefully acknowledge the radiological technologists, nurses, and staff of Departments of Neurosurgery, Tokyo Women’s Medical University in preparing this paper.

Declaration of Funding Source

This study was supported by research funds of Department of Neurosurgery, Tokyo Women’s Medical University.

Conflict of Interest Disclosure

The authors have no personal financial or institutional interest in any of the materials or devices described in this article.

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Affiliations

  1. Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Akiyoshi Yokote, Seiichiro Eguchi & Yoshikazu Okada

  2. Department of Neurosurgery Neurological Institute, Tokyo Women’s Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan

    Yasuo Aihara

Authors
  1. Akiyoshi Yokote
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  2. Yasuo Aihara
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  3. Seiichiro Eguchi
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  4. Yoshikazu Okada
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Corresponding author

Correspondence to Yasuo Aihara.

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Yokote, A., Aihara, Y., Eguchi, S. et al. Intraoperative pre- and post-craniofacial reconstruction intracranial pressure (ICP) monitoring in children with craniosynostosis. Childs Nerv Syst 29, 1363–1367 (2013). https://doi.org/10.1007/s00381-013-2049-0

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  • DOI: https://doi.org/10.1007/s00381-013-2049-0

Keywords

  • Craniosynostosis
  • Intracranial pressure (ICP)
  • Operative indication