Successful treatment of post-shunt craniocerebral disproportion by coupling gradual external cranial vault distraction with continuous intracranial pressure monitoring

2013 ◽  
Vol 11 (6) ◽  
pp. 653-657 ◽  
Author(s):  
Adam L. Sandler ◽  
Lawrence B. Daniels ◽  
David A. Staffenberg ◽  
Eliezer Kolatch ◽  
James T. Goodrich ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Temporal Correlation ◽  
Cranial Vault ◽  
Intracranial Volume ◽  
Icp Monitoring ◽  
Plateau Waves ◽  
Craniocerebral Disproportion ◽  
Reproducible Method ◽  
Definition Of ◽  
Cranial Expansion

A subset of hydrocephalic patients in whom shunts are placed at an early age will develop craniocerebral disproportion (CCD), an iatrogenic mismatch between the fixed intracranial volume and the growing brain. The lack of a reliable, reproducible method to diagnose this condition, however, has hampered attempts to treat it appropriately. For those practitioners who acknowledge the need to create more intracranial space in these patients, the lack of agreed-upon therapeutic end points for cranial vault expansion has limited the use of such techniques and has sometimes led to problems of underexpansion. Here, the authors present a definition of CCD based primarily on the temporal correlation of plateau waves on intracranial pressure (ICP) monitoring and headache exacerbation. The authors describe a technique of exploiting continued ICP monitoring during progressive cranial expansion in which the goal of distraction is the cessation of plateau waves. Previously encountered problems of underexpansion may be mitigated through the simultaneous use of ICP monitors and gradual cranial expansion over time.

Intracranial volume versus static and pulsatile intracranial pressure values in children with craniosynostosis

2019 ◽  
Vol 24 (1) ◽  
pp. 66-74 ◽  
Author(s):  
Erlend Aambø Langvatn ◽  
Radek Frič ◽  
Bernt J. Due-Tønnessen ◽  
Per Kristian Eide
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Brain Tissue ◽  
Wave Amplitude ◽  
Cranial Vault ◽  
Intracranial Volume ◽  
Raised Intracranial Pressure ◽  
Pathophysiological Mechanisms ◽  
Patient Cohort ◽  
Before And After

OBJECTIVEReduced intracranial volume (ICV) and raised intracranial pressure (ICP) are assumed to be principal pathophysiological mechanisms in childhood craniosynostosis. This study examined the association between ICV and ICP and whether ICV can be used to estimate the ICP.METHODSThe authors analyzed ICV and ICP measurements from children with craniosynostosis without concurrent hydrocephalus and from age-matched individuals without craniosynostosis who underwent diagnostic ICP measurement.RESULTSThe study included 19 children with craniosynostosis (mean age 2.2 ± 1.9 years) and 12 reference individuals without craniosynostosis (mean age 2.5 ± 1.6 years). There was no difference in ICV between the patient and reference cohorts. Both mean ICP (17.1 ± 5.6 mm Hg) and mean wave amplitude (5.9 ± 2.6 mm Hg) were higher in the patient cohort. The results disclosed no significant association between ICV and ICP values in the patient or reference cohorts, and no association was seen between change in ICV and ICP values after cranial vault expansion surgery (CVES) in 5 children in whom ICV and ICP were measured before and after CVES.CONCLUSIONSIn this cohort of children with craniosynostosis, there was no significant association between ICV and ICP values prior to CVES and no significant association between change in ICV and ICP values after CVES in a subset of patients. Therefore, ICV could not reliably estimate the ICP values. The authors suggest that intracranial hypertension in childhood craniosynostosis may not be caused by reduced ICV alone but rather by a distorted relationship between ICV and the volume of intracranial content (brain tissue, CSF, and blood).

Increases in Cranial Volume with Posterior Cranial Vault Distraction in 31 Consecutive Cases

Neurosurgery ◽  
2017 ◽  
Vol 81 (5) ◽  
pp. 803-811 ◽  
Author(s):  
Niina Salokorpi ◽  
Ville Vuollo ◽  
Juha-Jaakko Sinikumpu ◽  
Leonid Satanin ◽  
Heleia Nestal Zibo ◽  
...  
Keyword(s):  
Cranial Vault ◽  
Outpatient Clinics ◽  
Radiation Doses ◽  
Intracranial Volume ◽  
Volume Increase ◽  
3 Dimensional ◽  
Skull Radiographs ◽  
The Mean ◽  
Cranial Expansion

Abstract BACKGROUND Posterior cranial vault distraction (PCVD) is a technique widely used in surgical treatment of craniosynostosis when cranial expansion is required. It has proven to be safe and to allow a significant increase of intracranial volume. OBJECTIVE To evaluate increases in intracranial volume as a result of PCVD performed in Oulu Craniofacial center using 2 different methods based on 3-dimensional (3-D) photogrammetric imaging or plain skull radiographs. METHODS All children less than 16 yr of age who were treated by PCVD (n = 31) from 2009 to 2015 at the Oulu Craniofacial Center were included. All patients were followed at outpatient clinics with plain radiographs performed for follow-up. In 5 patients, additional 3-D photogrammetric imaging was done pre- and postoperatively. RESULTS The mean intracranial volume increase was 25.0%, ranging from 16.9% to 39.4%. In 5 patients, the increase in volume was calculated from the photogrammetric 3-D images comprising a mean of 17.4%. Volume calculations from cephalograms in the same patients gave a mean of 20.8%. Whether the distraction was a primary operation or patient had undergone previous cranioplasty did not influence the achieved volumetric results. There were no statistically significant differences in the distraction results between different diagnostic groups. CONCLUSION PCVD is an effective surgical method to increase intracranial volume in a variety of clinical entities. Volumetric results of this procedure could be easily evaluated using 3-D photogrammetric imaging or plane radiographs that expose the patients to only low ionizing radiation doses.

scholarly journals Cortical Pressure Injury: A Hypothesis to Explain the Incongruity of Clinical and Radiologic Improvement in Decompressive Craniectomy

2019 ◽  
Vol 08 (03) ◽  
pp. 188-190
Author(s):  
Sudip Kumar Sengupta ◽  
Harjinder Singh Bhatoe
Keyword(s):  
Intracranial Pressure ◽  
Clinical Outcome ◽  
Decompressive Craniectomy ◽  
Cranial Vault ◽  
Intracranial Volume ◽  
Anatomy And Physiology ◽  
Pressure Injury ◽  
The Brain ◽  
Shared Problem

AbstractIt has astonished neuroscientists since the advent of decompressive craniectomy as to why a seemingly successfully achieved goal of reduction in intracranial pressure (ICP), by removing a portion of the cranial vault and the resultant intracranial volume augmentation, fails to give the desired beneficial clinical outcome in every case and in fact, at times, proves to be deleterious in some conditions with a shared problem of refractory raised ICP. The authors propose a hypothesis based on the understanding of the anatomy and physiology of the brain that can explain the fallacy.

scholarly journals Intraoperative Measurement of Intracranial Pressure During Cranial Vault Remodeling in Children with Craniosynostosis

2022 ◽  
Author(s):  
Sonia Bansal ◽  
Subhas Konar ◽  
Dhaval Shukla ◽  
Dwarakanath Srinivas ◽  
Vishram Pandey ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intraoperative Monitoring ◽  
External Ventricular Drainage ◽  
Cranial Vault ◽  
Icp Monitoring ◽  
Height Reduction ◽  
Csf Diversion ◽  
The Mean ◽  
Entire Procedure ◽  
Cranial Vault Remodeling

Abstract Purpose In this study, we analyzed the utility of intracranial pressure (ICP) monitoring intraoperatively for deciding height reduction and need for cerebrospinal fluid (CSF) diversion during cranial vault remodeling in children with multisutural craniosynostosis (CS). Methods This is a retrospective observational study of children who underwent surgery for CS and ICP monitoring during surgery. The ICP was monitored using an external ventricular drainage catheter. The ICP monitoring was continued during the entire procedure. Results A total of 28 (19 boys) children with the involvement of two or more sutures underwent ICP monitoring during surgery. The commonest pattern of suture involvement was bicoronal seen in 16 (57.1%) children followed by pancraniosynostoses in eight (28.6%) cases. The mean opening ICP was 23 mm Hg, which dropped to 10.9 mm Hg after craniotomy. The ICP increased transiently to 19.5 mm Hg after height reduction, and the mean ICP at closure was 16.2 mm Hg. The ICP recordings helped in undoing the height reduction in two children and ventriculoperitoneal shunt after surgery in two children. Conclusions Intraoperative monitoring of ICP helps in deciding the type of cranial vault remodeling and the need for CSF diversion after surgery.

Relationship Between Intracranial Pressure and Intracranial Volume in Craniosynostosis

1993 ◽  
Vol 4 (3) ◽  
pp. B1
Author(s):  
H. Fok ◽  
B. M. Jones ◽  
D. G. Gault ◽  
U. Andar ◽  
R. Hayward ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Volume

Intracranial Pressure and Intracranial Volume in Children with Craniosynostosis

1993 ◽  
Vol 4 (3) ◽  
pp. 188 ◽  
Author(s):  
D. T. Gault ◽  
D. Renier ◽  
D. Marchac ◽  
B. M. Jones ◽  
Barry L. Eppley
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Volume

scholarly journals The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature

2014 ◽  
Vol 14 (6) ◽  
pp. 674-681 ◽  
Author(s):  
Steven A. Wall ◽  
Gregory P. L. Thomas ◽  
David Johnson ◽  
Jo C. Byren ◽  
Jayaratnam Jayamohan ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Nonoperative Management ◽  
Raised Intracranial Pressure ◽  
Corrective Surgery ◽  
Icp Monitoring ◽  
Noninvasive Method ◽  
Radiological Findings ◽  
Indication For Surgery ◽  
Sagittal Craniosynostosis ◽  
Significant Difference

Object The presence of raised intracranial pressure (ICP) in untreated nonsyndromic, isolated sagittal craniosynostosis (SC) is an important functional indication for surgery. Methods A retrospective review was performed of all 284 patients presenting with SC to the Oxford Craniofacial Unit between 1995 and 2010. Results Intraparenchymal ICP monitoring was performed in 39 children following a standard unit protocol. Monitoring of ICP was offered for all patients in whom nonoperative management was considered on the basis of minimal deformity or in cases in which parents were reluctant to agree to corrective surgery. These patients presented at an older age than the rest of the cohort (mean age 56 months), with marked scaphocephaly (16/39, 41%), mild scaphocephaly (11, 28%), or no scaphocephalic deformity (12, 31%). Raised ICP was found in 17 (44%) patients, with no significant difference in its incidence among the 3 different deformity types. Raised ICP was not predicted by the presence of symptoms of ICP or developmental delay or by ophthalmological or radiological findings. Conclusions The incidence of raised ICP in SC reported here is greater than that previously published in the literature. The lack of a reliable noninvasive method to identify individuals with elevated ICP in SC mandates consideration of intraparenchymal ICP monitoring in all patients for whom nonoperative management is contemplated.

scholarly journals Endoscopic assisted suturectomy for primary craniosynostosis in infancy

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Intracranial Pressure ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Teaching Hospital ◽  
Head Circumference ◽  
Analytical Study ◽  
Intracranial Volume ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Skull Shape

Background: Multiple procedures have been used for the treatment of craniosynostosis, ranging from simple suturectomy to extensive calvarial vault remodeling. The optimal timing for surgery is still controversial. The goal of therapy is to provide adequate intracranial volume, in addition to an aesthetically almost normal skull shape. Endoscopic synostosis repair described in 1998 by Jimenez and Baron [1]. This technique allows for a less invasive method that can result in excellent longstanding reconstruction of the cranial skeleton. This method is a minimally invasive approach that has less morbidity involved with traditional reconstruction techniques. Aim: Evaluation of early endoscopic suturectomy and its impact on both neurological functions and cosmetic appearance of infants up to 6 months of age suffering primary craniosynostosis. Methodology: This is a prospective analytical study of 50 patients with primary non syndromic craniosynostosis either single suture or multiple sutures, up to sixth months of age; with evident of skull shape deformity and or manifestations of increase intracranial pressure. from; October 2009 to October 2016 were managed byendoscopic assisted suturectomy the approach of Jimenez and Baron, in both Neurosurgery Department Shebin Elkom teaching hospital and Neurosurgery Department in Elsahel teaching hospital. Clinical and radiological follow up for six months postoperative. Results: This is a prospective analytical study of 50 patients with primary craniosynostosis, 28 patients are male and 22 patients are female. The age of patients range from one and half months to sixth months. The majority of cases presented with deformity alone 68%. Other clinical presentations as manifestations of increased intracranial pressure, fits, and delayed milestones plus deformity was 20%, 8%, and 4% respectively. Estimated blood loss, the mean loss was 56cc, minimum 30cc, and maximum was 100cc, with stander deviation ±18cc.The minimum hospital stay was one day and maximum was three days.There is significant change of head shape and head circumference postoperatively this observed by highly significant P value in head circumference (< 0.001). Conclusion: Endoscopic assisted suturectomy is minimally invasive approach with a very narrow range of complications, very limited need to blood transfusion and if it occurs, it is small volume in relation to total volume. Very short ICU and hospital stay also decrease the economic load.

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