Intracranial pressure in craniostenosis

Restricted access

✓ In this study, intracranial pressure (ICP) was recorded with an epidural ensor 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.

Article Information

Address reprint requests to: Dominique Renier, M.D., Hôpital Necker Enfants Malades, Service de Neurochirurgie Pédiatrique, 149 Rue de Sèvres, 75730 Paris, Cedex 15, France.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Age at time of intracranial pressure recording in 92 cases of craniosynostosis.

  • View in gallery

    Intracranial pressure recordings in three patients illustrating three different patterns during sleep. For a description see text.

  • View in gallery

    Intracranial pressure (ICP) during REM sleep in craniosynostosis. Upper: Mean number of eye movements per 10 seconds. Center: Mean electroencephalographic (EEG) frequency (arbitrary units). Lower: Mean ICP recordings in mm Hg. The means were computed every 10 seconds. On the middle curve during the 1st hour, EEG frequency is high and the subject is first in light sleep (Stage 1 or 2, with no eye movements) then in REM sleep. Afterward, EEG frequency gets slower, indicating that the subject enters deep sleep (Stage 3 or 4).

  • View in gallery

    Distribution of intracranial pressure (ICP) values according to the number of fused sutures. White blocks = less than or equal to 10 mm Hg; crossed blocks = 10 to 15 mm Hg; double-crossed blocks = more than 15 mm Hg.

  • View in gallery

    Intracranial pressure (ICP) recording in a patient with scaphocephaly, preoperatively (upper), and 15 days (center) and 4.5 months postoperatively (lower). There is a progressive return to a normal ICP level.

  • View in gallery

    Relationship between intracranial pressure (ICP) levels in slow-wave (SW) and REM sleep. The ICP given for REM sleep is the value recorded at the peak of the wave of increased ICP.

  • View in gallery

    Pre- and postoperative relationship between intracranial pressure (ICP) in slow-wave (SW) and REM sleep.

  • View in gallery

    Relationship between intelligence quotient (IQ) and intracranial pressure (ICP) during slow-wave (left) and REM (right) sleep.

  • View in gallery

    Relationship between age (in years) and intracranial pressure (ICP) during slow-wave (left) and REM (right) sleep.

References

  • 1.

    Barritault LRimbert JNHirsch JFet al: Vasomotor origin of intracranial pressure waves in hydrocephalic infants. Eur J Nucl Med 5:5115141980Barritault L Rimbert JN Hirsch JF et al: Vasomotor origin of intracranial pressure waves in hydrocephalic infants. Eur J Nucl Med 5:511–514 1980

    • Search Google Scholar
    • Export Citation
  • 2.

    Cooper RHulme A: Intracranial pressure and related phenomena during sleep. J Neurol Neurosurg Psychiatry 29:5645701966Cooper R Hulme A: Intracranial pressure and related phenomena during sleep. J Neurol Neurosurg Psychiatry 29:564–570 1966

    • Search Google Scholar
    • Export Citation
  • 3.

    de Rougemont J: Méthodes de mesure de la pression intra-crânienne. Neurochirurgie 20:4734881974de Rougemont J: Méthodes de mesure de la pression intra-crânienne. Neurochirurgie 20:473–488 1974

    • Search Google Scholar
    • Export Citation
  • 4.

    Di Rocco CIannelli AVelardi F: Early diagnosis and surgical indication in craniosynostosis. Childs Brain 6:1751881980Di Rocco C Iannelli A Velardi F: Early diagnosis and surgical indication in craniosynostosis. Childs Brain 6:175–188 1980

    • Search Google Scholar
    • Export Citation
  • 5.

    Gilland OTourtelotte WWO'Tauma Let al: Normal cerebrospinal fluid pressure. J Neurosurg 40:5875931974Gilland O Tourtelotte WW O'Tauma L et al: Normal cerebrospinal fluid pressure. J Neurosurg 40:587–593 1974

    • Search Google Scholar
    • Export Citation
  • 6.

    Gobiet WStrahl EWBock WJet al: Direct measurement of ICP in cases of craniosynostosis as a diagnostic aid for operation in Beks JWFBosch DABrock M (eds): Intracranial Pressure III. Berlin/Heidelberg/New York: Springer-Verlag1976 pp 336339Gobiet W Strahl EW Bock WJ et al: Direct measurement of ICP in cases of craniosynostosis as a diagnostic aid for operation in Beks JWF Bosch DA Brock M (eds): Intracranial Pressure III. Berlin/Heidelberg/New York: Springer-Verlag 1976 pp 336–339

    • Search Google Scholar
    • Export Citation
  • 7.

    Hirsch JCPierre-Kahn AHirsch JF: Experimental study of intracranial pressure during rapid eye movement sleep in the chronic cat. Neurosci Letters 7:2452491978Hirsch JC Pierre-Kahn A Hirsch JF: Experimental study of intracranial pressure during rapid eye movement sleep in the chronic cat. Neurosci Letters 7:245–249 1978

    • Search Google Scholar
    • Export Citation
  • 8.

    Hirsch JFLacombe JBarritault Let al: Pression intracrânienne et volume sanguin cérébral chez le nourrisson hydrocéphale au cours du sommeil. Neurochirurgie 25:31361979Hirsch JF Lacombe J Barritault L et al: Pression intracrânienne et volume sanguin cérébral chez le nourrisson hydrocéphale au cours du sommeil. Neurochirurgie 25:31–36 1979

    • Search Google Scholar
    • Export Citation
  • 9.

    Hirsch JFPierre-Kahn AGabersek V: Intracranial pressure and rapid eye movement sleep in hydrocephalus, as presented at the Second Meeting of the International Society for Paediatric NeurosurgeryLondon1974Hirsch JF Pierre-Kahn A Gabersek V: Intracranial pressure and rapid eye movement sleep in hydrocephalus as presented at the Second Meeting of the International Society for Paediatric Neurosurgery London 1974

  • 10.

    Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36 (Suppl 149): 11931960Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36 (Suppl 149):1–193 1960

    • Search Google Scholar
    • Export Citation
  • 11.

    Letourneux M: La mesure de la pression intra-crânienne par palpeur de fontanelle chez 32 nouveaux-nés bien portants. Thesis Paris1980Letourneux M: La mesure de la pression intra-crânienne par palpeur de fontanelle chez 32 nouveaux-nés bien portants. Thesis Paris 1980

    • Search Google Scholar
    • Export Citation
  • 12.

    Marchac DCophignon JHirsch JFet al: Remodelage fronto-crânien des craniosténoses avec mobilisation du bandeau frontal. Neurochirurgie 24:23311978Marchac D Cophignon J Hirsch JF et al: Remodelage fronto-crânien des craniosténoses avec mobilisation du bandeau frontal. Neurochirurgie 24:23–31 1978

    • Search Google Scholar
    • Export Citation
  • 13.

    Marchac DRenier D: Craniofacial Surgery for Craniosynostosis. Boston: Little, Brown and Co1981 (In press)Marchac D Renier D: Craniofacial Surgery for Craniosynostosis. Boston: Little Brown and Co 1981 (In press)

    • Search Google Scholar
    • Export Citation
  • 14.

    Marchac DRenier D: “Le front flottant.” Traitement précoce des facio-craniosténoses. Ann Chir Plast 24:1211261979Marchac D Renier D: “Le front flottant.” Traitement précoce des facio-craniosténoses. Ann Chir Plast 24:121–126 1979

    • Search Google Scholar
    • Export Citation
  • 15.

    Montaut JStricker M: Les dysmorphies cranio-faciales. Les synostoses prématurées (crâniosténoses et faciosténoses). Neurochirurgie 23 (Suppl 2): 12991977Montaut J Stricker M: Les dysmorphies cranio-faciales. Les synostoses prématurées (crâniosténoses et faciosténoses). Neurochirurgie 23 (Suppl 2):1–299 1977

    • Search Google Scholar
    • Export Citation
  • 16.

    Pierre-Kahn AGabersek VHirsch JF: Intracranial pressure and rapid eye movement sleep in hydrocephalus. Childs Brain 2:1561661976Pierre-Kahn A Gabersek V Hirsch JF: Intracranial pressure and rapid eye movement sleep in hydrocephalus. Childs Brain 2:156–166 1976

    • Search Google Scholar
    • Export Citation
  • 17.

    Pierre-Kahn AGabersek VHirsch JF: Phase paradoxale du sommeil et pression intra-crânienne au cours de l'hydrocéphalie stabilisé. Rrev Electroencephalogr Neurophysiol Clin 5:591975Pierre-Kahn A Gabersek V Hirsch JF: Phase paradoxale du sommeil et pression intra-crânienne au cours de l'hydrocéphalie stabilisé. Rev Electroencephalogr Neurophysiol Clin 5:5–9 1975

    • Search Google Scholar
    • Export Citation
  • 18.

    Pierre-Kahn AHirsch JCRenier Det al: Étude des relations de la pression intra-crânienne et du sommeil paradoxal chez le chat. Neurochirurgie 24:2512551978Pierre-Kahn A Hirsch JC Renier D et al: Étude des relations de la pression intra-crânienne et du sommeil paradoxal chez le chat. Neurochirurgie 24:251–255 1978

    • Search Google Scholar
    • Export Citation
  • 19.

    Renier DMarchac DSainte-Rose Cet al: Traitement actuel des craniosténoses. Med Infantile 88:3173431981Renier D Marchac D Sainte-Rose C et al: Traitement actuel des craniosténoses. Med Infantile 88:317–343 1981

    • Search Google Scholar
    • Export Citation
  • 20.

    Robinson RORolfe PSutton P: Non-invasive method for measuring intracranial pressure in normal newborn infants. Dev Med Child Neurol 19:3053081977Robinson RO Rolfe P Sutton P: Non-invasive method for measuring intracranial pressure in normal newborn infants. Dev Med Child Neurol 19:305–308 1977

    • Search Google Scholar
    • Export Citation
  • 21.

    Rossi GFPaira GVignatti A: Intracranial pressure during sleep in man in Levin PKoella WP (eds): Sleep 1974. Second European Congress on Sleep Research. Rome 1974. Basel/New York: S Karger1975 pp 169180Rossi GF Paira G Vignatti A: Intracranial pressure during sleep in man in Levin P Koella WP (eds): Sleep 1974. Second European Congress on Sleep Research. Rome 1974. Basel/New York: S Karger 1975 pp 169–180

    • Search Google Scholar
    • Export Citation
  • 22.

    Sainte-Rose CLacombe JRenier Det al: Mesure de la pression intra-crânienne chez l'enfant et le nourrisson. Med Infantile 88:2832941981Sainte-Rose C Lacombe J Renier D et al: Mesure de la pression intra-crânienne chez l'enfant et le nourrisson. Med Infantile 88:283–294 1981

    • Search Google Scholar
    • Export Citation
  • 23.

    Sainte-Rose CRenier DPierre-Kahn Aet al: Apport de l'enregistrement continu de la pression intra-crânienne en neurochirurgie pédiatrique. Rev Pediatr 16:5395521980Sainte-Rose C Renier D Pierre-Kahn A et al: Apport de l'enregistrement continu de la pression intra-crânienne en neurochirurgie pédiatrique. Rev Pediatr 16:539–552 1980

    • Search Google Scholar
    • Export Citation
  • 24.

    Salmon JHHajjar WBada HS: The fontogram: a noninvasive intracranial pressure monitor. Pediatrics 60:7217251977Salmon JH Hajjar W Bada HS: The fontogram: a noninvasive intracranial pressure monitor. Pediatrics 60:721–725 1977

    • Search Google Scholar
    • Export Citation
  • 25.

    Scarfò GBTomaccini DGambacorta Det al: Contribution to the study of craniostenosis: disturbance of the cerebrospinal fluid flow in oxycephaly. Helv Paediat Acta 34:2352431979Scarfò GB Tomaccini D Gambacorta D et al: Contribution to the study of craniostenosis: disturbance of the cerebrospinal fluid flow in oxycephaly. Helv Paediat Acta 34:235–243 1979

    • Search Google Scholar
    • Export Citation
  • 26.

    van Effenterre RHoutteville JPPhilippon Jet al: Intérêt de la mesure de la pression intra-crânienne dans les craniosténoses découvertes après l'âge d'un an. Neurochirurgie 22:59671976van Effenterre R Houtteville JP Philippon J et al: Intérêt de la mesure de la pression intra-crânienne dans les craniosténoses découvertes après l'âge d'un an. Neurochirurgie 22:59–67 1976

    • Search Google Scholar
    • Export Citation
  • 27.

    Vidyasagar DRaju TNK: A simple noninvasive technique of measuring intracranial pressure in the newborn. Pediatrics 59:9579611977Vidyasagar D Raju TNK: A simple noninvasive technique of measuring intracranial pressure in the newborn. Pediatrics 59:957–961 1977

    • Search Google Scholar
    • Export Citation
  • 28.

    Zazzo RGilly MVerba-Rad M: Nouvelle Echelle Métrique de l'Intelligence. Paris: Armand Colin19662 volsZazzo R Gilly M Verba-Rad M: Nouvelle Echelle Métrique de l'Intelligence. Paris: Armand Colin 1966 2 vols

    • Search Google Scholar
    • Export Citation

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 253 253 36
Full Text Views 322 322 4
PDF Downloads 165 165 3
EPUB Downloads 0 0 0

PubMed

Google Scholar