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

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OBJECTIVE

Reduced 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.

METHODS

The 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.

RESULTS

The 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.

CONCLUSIONS

In 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).

ABBREVIATIONS CVES = cranial vault expansion surgery; ICC = intracranial compliance; ICP = intracranial pressure; ICV = intracranial volume; MWA = mean ICP wave amplitude; OSA = obstructive sleep apnea.

Article Information

Correspondence Per Kristian Eide: Oslo University Hospital—Rikshospitalet, Oslo, Norway. p.k.eide@medisin.uio.no.

INCLUDE WHEN CITING Published online April 19, 2019; DOI: 10.3171/2019.2.PEDS18767.

E.A.L. and R.F. contributed equally to this work.

Disclosures Dr. Eide has an ownership stake in the software company, dPCom AS, that manufactures the software (Sensometrics) used for analysis of the ICP recordings.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    The method of estimating intracranial volume, in this case from an MRI scan. Figure is available in color online only.

  • View in gallery

    The association between ICV and mean ICP (A) and MWA (B) of craniosynostosis patients, and between ICV and mean ICP (C) and MWA (D) of reference subjects. For each plot the fit line and the Pearson correlation coefficient (R) with significance level are presented.

  • View in gallery

    The association between change in ICV and change in mean ICP (upper) and change in MWA (lower) after CVES in 5 patients with craniosynostosis. For each plot the fit line and the Pearson correlation coefficient (R) with significance level are presented.

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