Related Experiment Video
Updated: Mar 21, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Lumbar Puncture Pressures During Childhood in 262 Children with Craniosynostosis
1Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea.
Insights
Lumbar puncture pressures (LPPs) in children with craniosynostosis increase slowly with age. An age-adjusted cutoff for LPP is more effective for identifying elevated pressures than a fixed threshold.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Neurology
Background:
- Craniosynostosis, a condition involving premature fusion of skull sutures, can lead to increased intracranial pressure.
- Accurate assessment of lumbar puncture pressure (LPP) is crucial for managing craniosynostosis and guiding surgical interventions.
- Existing LPP thresholds may not adequately account for age-related physiological variations in pediatric patients.
Purpose of the Study:
- To analyze age-dependent lumbar puncture pressures (LPPs) in a cohort of 262 children diagnosed with craniosynostosis.
- To establish normative LPP data that considers age-specific changes in pediatric patients with craniosynostosis.
- To provide data to assist in surgical decision-making for craniosynostosis.
Main Methods:
- A retrospective analysis of 262 children with craniosynostosis who underwent LPP measurement between July 2005 and June 2014.
- Comparison of LPP with demographic and clinical data including age, gender, birth weight, head circumference, and gestational age.
- Statistical modeling to describe the relationship between age and LPP in different craniosynostosis subtypes.
Main Results:
- Lumbar puncture pressure (LPP) demonstrated a slow, steady increase with age in children with craniosynostosis, following specific polynomial trends for overall, single-suture, and multiple/syndromic craniosynostosis.
- A significant proportion (59.9%) of children initially presented with LPPs exceeding 20 cm H2O.
- When LPP cutoff levels were adjusted for age, the detection rate of elevated pressures increased dramatically to 99.2%, with 63.4% of these identified as having increased LPP under the new criterion.
Conclusions:
- Lumbar puncture pressure (LPP) in children with craniosynostosis exhibits a gradual age-dependent increase.
- Elevated LPP rates in this pediatric craniosynostosis cohort were higher than previously anticipated.
- An age-adjusted LPP cutoff criterion offers a more sensitive and clinically relevant assessment tool compared to a fixed threshold for all pediatric age groups.
Objective:
The aim of this study was to analyze age-dependent lumbar puncture pressures (LPPs) measured in 262 children with craniosynostosis to provide information that assists in determining surgery.
Methods:
From 1 July 2005 to 30 June 2014, 262 children with craniosynostosis diagnosed at the Department of Neurosurgery, Ajou University Hospital, underwent LPP measurement. These children were compared with respect to age, gender, birth weight, head circumference at the time of birth, gestational age, LPP, and developmental assessments.
Results:
Changes in LPP in children with craniosynostosis according to age were y = -0.0007x(2) + 0.1327x + 21.678 in all patients overall, y = -0.0003x(2) + 0.1166x + 21.466 in children with single-suture craniosynostosis, and y = -0.002x(2) + 0.248x + 22.55 in patients with multiple and syndromic craniosynostosis, indicating a steady and slow increase from birth until the age of 4 years. Also, 59.9% of the 262 children had LPP greater than 20 cm H2O, but when the LPP cutoff level was adjusted for age, this proportion was 99.2%; the new criterion after the adjusted LPP cutoff level showed that for those with increased LPP, the proportion was 63.4%.
Conclusions:
We suggest that LPP increases slowly with age in children with craniosynostosis, increased LPP rates in children with craniosynostosis were higher than previously expected, and the new cutoff level criterion that adjusts for age may be more helpful than a fixed cutoff level for all ages.
