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Lumbar pressure and transcranial Doppler sonography in children with scaphocephaly

D Horínek1, D Hoza, A Tomek

  • 1Department of Neurosurgery, 1st Medical School, Central Military Hospital, Prague, Czech Republic. dhori@email.cz

British Journal of Neurosurgery
|March 19, 2008
PubMed

Insights

In children with scaphocephaly, elevated lumbar cerebrospinal fluid (CSF) pressure is common, particularly in older infants. However, transcranial Doppler (TCD) measurements of intracranial blood flow do not reliably predict abnormal CSF pressure.

Area of Science:

  • Pediatric Neurosurgery
  • Neurology
  • Medical Imaging

Background:

  • Scaphocephaly, a premature fusion of the sagittal suture, can impact intracranial pressure.
  • Understanding the relationship between cerebrospinal fluid (CSF) pressure and intracranial hemodynamics is crucial for managing pediatric neurodevelopmental disorders.

Purpose of the Study:

  • To investigate the association between lumbar cerebrospinal fluid (CSF) pressure and intracranial blood flow velocities in children with scaphocephaly.
  • To evaluate the efficacy of transcranial Doppler (TCD) in assessing intracranial hemodynamics before and after cranioplasty.
  • To compare TCD-derived indices (Pulsatility Index [PI] and Resistance Index [RI]) with lumbar CSF pressure (LP) measurements.

Main Methods:

  • Lumbar CSF pressure (LP) was measured in 21 children diagnosed with scaphocephaly.
  • Transcranial Doppler (TCD) sonography was performed to obtain Pulsatility Index (PI) and Resistance Index (RI) values.
  • TCD measurements were recorded both preoperatively and postoperatively following cranioplasty.

Main Results:

  • Elevated LP was observed in 17 out of 21 children.
  • LP values were significantly higher in children older than 6 months.
  • No significant differences were found in PI and RI indices before and after cranioplasty.
  • No significant association was detected between LP and TCD-derived PI and RI indices.

Conclusions:

  • Children with scaphocephaly may exhibit higher lumbar CSF pressure, particularly as they age.
  • Transcranial Doppler (TCD) is not a reliable method for predicting abnormal lumbar CSF pressure in this patient population.
  • Further research is needed to explore alternative non-invasive methods for assessing intracranial pressure in pediatric craniosynostosis.

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