Sunday, October 28, 2007
13358

Reduction of Intracranial Pressure after Craniosynostosis Surgery

Lars H. Evers, MD, Dhaval Bhavsar, MD, Allen Ho, BS, Hal Meltzer, MD, Michael Levy, MD, PhD, and Steven Cohen, MD.

Introduction: Premature closure of cranial vault sutures may be related to chronically elevated intracranial pressure (ICP). The presence of raised ICP in craniosynostosis can be diagnosed on the basis of clinical and radiographic features as well as from invasive monitoring. In the management of craniosynostosis, we have found ICP monitoring with an intraparenchymal monitor to be a useful and safe means of identifying those children with raised ICP who would benefit from surgical intervention. We studied the role of cranial vault remodeling surgery in reducing increased ICP. Methods: Out of 190 patients who underwent surgery for craniofacial deformities (2002-2006), 16 patients had raised ICP diagnosed clinically and/ or with invasive monitoring, 12 of them evaluated solely by clinical signs such as papilledema and 4 with the addition of ICP monitoring. Continuous ICP monitoring was carried out for a minimum of 12 h. Sustained elevations of > 20 mm Hg during non REM sleep was considered diagnostic of pathologic ICP. Children with a history of previous cranial vault surgery or hydrocephalus were excluded from this study. Results: Of the 16 patients with evidence of intracranial hypertension studied following cranial vault surgery, all patients showed clinical improvement with resolution of papilledema and preoperative symptoms such as headache. No patient in follow-up has had evidence of permanent visual decline. Conclusion: The recognition of significant clinical symptoms and signs of intracranial hypertension in patients with craniosynostosis including in selected cases invasive ICP monitoring can aid in formulating a surgical management plan incorporating the need to normalize ICP as well as correct the frequently severe functional and cosmetic consequences of these disorders. A well-planned cranial vault reconstruction can significantly reduce pathologic ICP and prevent its attendant permanent neurological sequelae.