Intracranial pressure in craniostenosis
Abstract
In this study, intracranial pressure (ICP) was recorded with an epidural sensor for periods of 12 to 24 hours in 92 cases of craniosynostosis. Pre- and postoperative recordings were performed in 23 patients, and 55 children underwent preoperative psychometric testing. The ICP was found to be normal in one-third of the cases, was obviously elevated in one-third, and was borderline in one-third. Waves of increased ICP were recorded during rapid eye movement (REM) sleep. After surgery, ICP decreased progressively and returned to normal in several weeks. A significant statistical relationship was found between the patients' ICP and their mental level: the higher the ICP the lower the mental level. The regression curve of ICP as a function of age shows that ICP is maximal at the age of 6 years and decreases later. The significance of these results is discussed. The authors recommend that ICP be recorded in cases of craniosynostosis since it is of some help in deciding whether patients should undergo surgery.
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Increased intracranial pressure leads not only to visual problems but also to a delay in neurocognitive development.
“Increased intracranial pressure not only leads to visual problems but also to a delay in neurocognitive development.”
From Isolated Sagittal Craniosynostosis: A Comprehensive Review (2024) · cites this paper as [26]
Pathophysiological factors that may explain neurocognitive problems in ISS include increased intracranial pressure, deformation of the brain due to skull deformation, problems with normal brain development, and compression of venous sinuses with impaired venous outflow.
“A number of pathophysiological factors, alone or in combination, may explain the occurrence of neurocognitive problems associated with ISS:increased intracranial pressure [26],deformation of the brain as a result of deformation of the skull [27],problems with the normal development of the brain,compression of the venous sinuses with resulting impairment of venous outflow [14,28].”
From Isolated Sagittal Craniosynostosis: A Comprehensive Review (2024) · cites this paper as [26]
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BackgroundMethodResultInfluentialHydrocephalus and mental retardation in craniosynostosis
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BackgroundResultRecurrence of Synostosis following Surgical Repair of Craniosynostosis
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“The actual benefit of such surgical corrections in reducing the risk of developing raised ICP is currently unknown (7,10,22), although some studies have indicated that raised ICP can occur even after decompression and reshaping procedures for craniosynostosis (5,16).”
BackgroundInfluentialKeupp, K., Li, Y., Vargel, İ., Hoischen, A., Richardson, R. J., Neveling, K., Alanay, Y., Uz, E., Elcioglu, N. H., Rachwalski, M., et al. (2013) · Molecular Genetics & Genomic Medicine · doi:10.1002/mgg3.28 · Cited by 78 · see citing works
“Moreover, the pressure on the growing cerebral cortex results in an increased risk of intellectual disability (Renier et al. 1982).”
BackgroundBhalodia, R., Dvoracek, L. A., Ayyash, A. M., Kavan, L., Whitaker, R., & Goldstein, J. A. (2020) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000006215 · Cited by 78 · see citing works
Identifying the Misshapen Head: Craniosynostosis and Related Disorders
Dias, M. S., Samson, T. D., Rizk, E., Governale, L. S., Richtsmeier, J. T., & SECTION ON NEUROLOGIC SURGERY, S. O. P. A. R. S. (2020) · PEDIATRICS · doi:10.1542/peds.2020-015511 · Cited by 78 · see citing works
“Elevated ICP is present in 4% to 42% of children with single-suture craniosynostosis and approximately 50% to 68% with multisutural involvement; the incidence of intracranial hypertension is higher among older untreated individuals.(42,44) Elevated ICP correlates with developmental and cognitive outcomes in some studi…”
BackgroundKapp‐Simon, K. A., Leroux, B. G., Cunningham, M. L., & Speltz, M. L. (2005) · The Cleft Palate-Craniofacial Journal · doi:10.1597/04-044.1 · Cited by 78 · see citing works
“…with isolated fusions prior to a year of age have MDI scores that do not differ significantly from test norms or average control group performance (Renier et al., 1982; Kapp-Simon et al., 1993; Arnaud et al., 1995; Speltz et al., 1997; Kapp-Simon, 1998; DeLeon et al., 2000; Panchal et al., 2001).”
BackgroundResultMonitoring Visual Function in Children With Syndromic Craniosynostosis
Liasis, A. C. (2006) · Archives of Ophthalmology · doi:10.1001/archopht.124.8.1119 · Cited by 75 · see citing works
“Intracranial pressure has been estimated to affect 13% of unisutural(7) and 50% to 75% of multisutural CSs (which are more often seen in those with syndromic CS).(8,9) Objective methods of documenting increased ICP include the following: lumbar puncture, which regularly requires a general anesthetic(10); and transcran…”
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Eide, P. K., Helseth, E., Due‐Tønnessen, B. J., & Lundar, T. (2002) · Pediatric Neurosurgery · doi:10.1159/000066311 · Cited by 74 · see citing works
Pre- and postoperative developmental attainment in sagittal synostosis
Bellew, M. (2005) · Archives of Disease in Childhood · doi:10.1136/adc.2003.035824 · Cited by 74 · see citing works
Diagnostic imaging in the management of craniosynostoses
Kotrikova, B., Krempien, R. C., Freier, K., & Mühling, J. (2006) · European Radiology · doi:10.1007/s00330-006-0520-y · Cited by 73 · see citing works
“Reports of metopic synostosis patients with increased intracranial pressure are rare, but 14–55% of children with one prematurely fused suture (such as metopic synostosis) demonstrated significantly elevated intracranial pressure (>15 mmHg) [6, 58].”
BackgroundInfluentialSkull vault growth in craniosynostosis
Sgouros, S. (2005) · Child's Nervous System · doi:10.1007/s00381-004-1112-2 · Cited by 70 · see citing works
“Direct measurement with an intracranial bolt is an invasive diagnostic procedure with recognised complications [92, 110].”
MethodDean, D., Hans, M. G., Bookstein, F. L., & Subramanyan, K. (2000) · The Cleft Palate-Craniofacial Journal · doi:10.1597/1545-1569(2000)037 · Cited by 45 · see citing works
Papilledema in Isolated Single-Suture Craniosynostosis: Prevalence and Predictive Factors
Florisson, J. M. G., van Veelen, M.-L. C., Bannink, N., van Adrichem, L. N. A., van der Meulen, J. J. N. M., Bartels, M. C., & Mathijssen, I. M. J. (2010) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e3181c3465e · Cited by 71 · see citing works
Visual failure caused by raised intracranial pressure in craniosynostosis
Stavrou, P., Sgouros, S., Willshaw, H., Goldin, J., Hockley, A., & Wake, M. (1997) · Child's Nervous System · doi:10.1007/s003810050043 · Cited by 69 · see citing works
Plateau Waves in Head Injured Patients Requiring Neurocritical Care
Castellani, G., Zweifel, C., Kim, D., Carrera, E., Radolovich, D. K., Smielewski, P., Hutchinson, P. J., Pickard, J. D., & Czosnyka, M. (2009) · Neurocritical Care · doi:10.1007/s12028-009-9235-7 · Cited by 69 · see citing works
“GOS 3 [1, 3] 3 [2, 5] Ns”
BackgroundAviv, R. I., Rodger, E., & Hall, C. M. (2002) · Clinical Radiology · doi:10.1053/crad.2001.0836 · Cited by 69 · see citing works
Treatment of Craniosynostosis in Infancy
Marchac, D., & Rénier, D. (1987) · Clinics in Plastic Surgery · doi:10.1016/s0094-1298(20)30697-0 · Cited by 69 · see citing works
The intracranial pressure of the patients with mild form of craniosynostosis
Inagaki, T., Kyutoku, S., Seno, T., Kawaguchi, T., Yamahara, T., Oshige, H., Yamanouchi, Y., & Kawamoto, K. (2007) · Child s Nervous System · doi:10.1007/s00381-007-0436-0 · Cited by 68 · see citing works
Nagaraja, S., Anslow, P., & Winter, B. (2012) · Clinical Radiology · doi:10.1016/j.crad.2012.07.005 · Cited by 67 · see citing works
Computerized tomography of cranial sutures
Furuya, Y., Edwards, M. S. B., Alpers, C. E., Tress, B. M., Norman, D. M., & Ousterhout, D. K. (1984) · Journal of neurosurgery · doi:10.3171/jns.1984.61.1.0059 · Cited by 67 · see citing works
Computer-assisted virtual planning and surgical template fabrication for frontoorbital advancement
Soleman, J., Thieringer, F. M., Beinemann, J., Kunz, C., & Guzman, R. G. (2015) · Neurosurgical FOCUS · doi:10.3171/2015.3.focus14852 · Cited by 66 · see citing works
Isaac, K. V., Meara, J. G., & Proctor, M. R. (2018) · Journal of Neurosurgery: Pediatrics · doi:10.3171/2018.5.peds1846 · Cited by 64 · see citing works
“34,38,39 The incidence of raised ICP following primary surgical correction in single-suture SC ranges widely from 1.5% to 44% 1,2,5,29,34,35,40,41 and adja - cent synostoses occur following both ES 17,44 and CVR. 5,9,44 The addition of a syndromic diagnosis further increases the risk of restenosis…”
InfluentialEpidemiology of craniosynostosis in Norway
Tønne, E., Due-Tønnessen, B. J., Wiig, U., Stadheim, B. F., Meling, T. R., Helseth, E., & Heimdal, K. R. (2020) · Journal of Neurosurgery Pediatrics · doi:10.3171/2020.1.peds2051 · Cited by 66 · see citing works
The Subarachnoid Spaces in Craniosynostosis
Chadduck, W. M., Chadduck, J. B., & Boop, F. A. (1992) · Neurosurgery · doi:10.1227/00006123-199206000-00008 · Cited by 65 · see citing works
Evolution of Surgery for Sagittal Synostosis
Mackenzie, K. A., Davis, C., Yang, A. S., & MacFarlane, M. R. (2009) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e318190e1cf · Cited by 64 · see citing works
Nguyen, D. C., Patel, K., Skolnick, G., Naidoo, S. D., Huang, A., Smyth, M., & Woo, A. S. (2015) · The Journal of craniofacial surgery (Print) · doi:10.1097/scs.0000000000001321 · Cited by 65 · see citing works
“The 2 main goals of surgical management for metopic synostosis are normalization of cranial shape to facilitate peer acceptance and social integration, as well as expansion of the cranium to alleviate possibility of increased intracranial pressure.(10) The most common treatment for metopic craniosynostosis is fronto-o…”
BackgroundRottgers, S. A., Lohani, S., & Proctor, M. R. (2016) · Journal of Neurosurgery Pediatrics · doi:10.3171/2016.2.peds15693 · Cited by 63 · see citing works
van Veelen, M.-L. C., Eelkman Rooda, O. H. J., de Jong, T., Dammers, R., van Adrichem, L. N. A., & Mathijssen, I. M. J. (2013) · Child s Nervous System · doi:10.1007/s00381-013-2024-9 · Cited by 61 · see citing works
“However, if left uncorrected, 10–20 % will develop increased intracranial pressure (ICP) [7, 17, 19, 40, 41, 48].”
BackgroundPhenotypically Unusual Combined Craniosynostoses: Presentation and Management
Greene, A., Mulliken, J., Proctor, M., Meara, J., & Rogers, G. (2008) · Plastic and Reconstructive Surgery · doi:10.1097/prs.0b013e31817f45f0 · Cited by 57 · see citing works
Mooney, M. P., Siegel, M. I., Burrows, A. M., Smith, T. D., Losken, H. W., Dechant, J. J., Cooper, G., Fellows-Mayle, W. K., Kapucu, M. R., & Atay, L. Ö. (1998) · Child s Nervous System · doi:10.1007/s003810050220 · Cited by 59 · see citing works
Thomas, G. P. L., Wilkie, A. O. M., Richards, P. G., & Wall, S. A. (2005) · Journal of Craniofacial Surgery · doi:10.1097/01.scs.0000157024.56055.f2 · Cited by 58 · see citing works
Tamburrini, G., Caldarelli, M., Massimi, L., Gasparini, G. M., Pelo, S., & Rocco, C. D. (2012) · Child s Nervous System · doi:10.1007/s00381-012-1819-4 · Cited by 58 · see citing works
“Historically, the number of fused sutures has been related to ICP [54]; however, since early 1990s, many authors have highlighted the lack of a predictable correlation between intracranial volume and intracranial pressure, being the intracranial volume normal in most children with complex craniosynostoses or even enla…”
BackgroundRidgway, E. B., & Weiner, H. L. (2004) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2003.12.001 · Cited by 58 · see citing works
“Renier [6,16] noted that the elevated ICP is further aggravated by increased age and that early surgical intervention is corrective until 6 years of age, when cerebral atrophy begins to compensate.”
BackgroundInfluentialHankinson, T. C., Fontana, E. J., Anderson, R. C. E., & Feldstein, N. A. (2010) · Journal of Neurosurgery Pediatrics · doi:10.3171/2010.5.peds09313 · Cited by 57 · see citing works
Endoscopic Strip Craniectomy in Early Infancy
Meier, P. M., Goobie, S. M., DiNardo, J. A., Proctor, M. R., Zurakowski, D., & Soriano, S. G. (2010) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e31820471e4 · Cited by 57 · see citing works
“Infants with syndromic craniosynostosis are at risk for increased bleeding in the presence of increased intracranial and cranial venous pressure.(24,25) None of the infants undergoing initial ESC had clinical or radiographic evidence of increased intracranial pressure.”
BackgroundHydrocephalus in craniosynostosis
Collmann, H., Sörensen, N., Krauß, J., & Mühling, J. (1988) · Child s Nervous System · doi:10.1007/bf00271924 · Cited by 57 · see citing works
“It should be kept in mind that, after frontoorbital advancement, an interval of 2-4 months [20] is needed for readjustment of the cranial content and normalization of the intracranial pressure.”
BackgroundIntracranial pressure changes in arrested hydrocephalus
Whittle, I. R., Johnston, I. H., & Besser, M. (1985) · Journal of neurosurgery · doi:10.3171/jns.1985.62.1.0077 · Cited by 57 · see citing works
Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique
Mesa, J. M., Fang, F., Muraszko, K. M., & Buchman, S. R. (2011) · Neurosurgical FOCUS · doi:10.3171/2011.6.focus1193 · Cited by 56 · see citing works
Are routine preoperative CT scans necessary in the management of single suture craniosynostosis?
Cerovac, S., Neil-Dwyer, J., Rich, P. M., Jones, B. M., & Hayward, R. D. (2002) · British Journal of Neurosurgery · doi:10.1080/0268869021000007560 · Cited by 56 · see citing works
Papilledema in Patients With Apert, Crouzon, and Pfeiffer Syndrome
Bannink, N., Joosten, K. F. M., van Veelen, M. C., Bartels, M. C., Tasker, R. C., van Adrichem, L. N. A., van der Meulen, J. J. N. M., Vaandrager, J. M., de Jong, T. H. R., & Mathijssen, I. M. J. (2008) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e31815f4015 · Cited by 56 · see citing works
“In patients with either Apert or Crouzon syndrome, elevated ICP before vault expansion is seen in approximately 45% and 63%, respectively.(5,6) Untreated, elevated ICP may lead to irreversible visual loss caused by optic nerve dysfunction and mental impairment.”
BackgroundIntraoperative intracranial pressure monitoring in the pediatric craniosynostosis population
Judy, B. F., Swanson, J. W., Yang, W., Storm, P. B., Bartlett, S. P. P., Taylor, J. A., Heuer, G. G., & Lang, S. (2018) · Journal of Neurosurgery Pediatrics · doi:10.3171/2018.5.peds1876 · Cited by 56 · see citing works
Long-Term Results in Isolated Metopic Synostosis: The Oxford Experience over 22 Years
Natghian, H., Song, M., Jayamohan, J., Johnson, D., Magdum, S. A., Richards, P., & Wall, S. A. (2018) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000004768 · Cited by 55 · see citing works
Florisson, J. M. G., Barmpalios, G., Lequin, M. H., van Veelen, M. C., Bannink, N., Hayward, R. D., & Mathijssen, I. M. J. (2014) · Journal of Cranio-Maxillofacial Surgery · doi:10.1016/j.jcms.2014.11.023 · Cited by 55 · see citing works
- Authors
- Renier, D., Sainte-Rose, C., Marchac, D., & Hirsch, J.-F.
- Venue
- Journal of neurosurgery
- Published
- 1982-09
- Volume
- 57
- Issue
- 3
- Pages
- 370-377
- ISSN
- 0022-3085 (ISSN-L)
- OpenAlex
- W2032830902
- Cited by
- 591
- References
- 21
- Citations by year
- 2026: 18 · 2025: 9 · 2024: 28 · 2023: 23 · 2022: 29 · 2021: 34 · 2020: 21 · 2019: 23 · 2018: 31 · 2017: 28 · 2016: 20 · 2015: 19 · 2014: 18 · 2013: 19 · 2012: 17
- FWCI
- 3.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of neurosurgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Neurology › Cerebral Venous Sinus Thrombosis
- Keywords
- intracranial pressure, craniosynostosis, REM sleep, mental status, craniosynostosis surgery, pediatric patients
- MeSH terms
- Adolescent, Child, Child, Preschool, Craniosynostoses, Female, Humans, Infant, Intelligence, Intracranial Pressure, Male, Postoperative Period, Sleep, Sleep, REM
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