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Dural sinus volume in children with syndromic craniosynostosis and intracranial hypertension
Robbin de Goederen1, Iris E Cuperus1, Robert C Tasker2
1Departments of1Plastic and Reconstructive Surgery, and Hand Surgery.
Insights
Children with syndromic craniosynostosis and intracranial hypertension do not show increased total cerebral venous volume. However, an enlarged straight sinus volume is linked to higher intracranial pressure in these patients.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Neuroradiology
Background:
- Intracranial hypertension is a significant complication in children with syndromic craniosynostosis (sCS).
- Cerebral venous hypertension due to outflow obstruction is a suspected contributor to intracranial hypertension in sCS.
- Understanding the venous system's role is crucial for managing sCS complications.
Purpose of the Study:
- To investigate the relationship between cerebral venous volume and intracranial hypertension in children with sCS.
- To determine if increased total cerebral venous volume or specific sinus volumes are associated with intracranial hypertension in sCS.
Main Methods:
- A case series of 105 children with sCS was analyzed.
- Cerebral MRI was used to quantify the volumes of the superior sagittal sinus, straight sinus (StrS), and transverse sinuses.
- Statistical analyses included linear regression, multivariate ANOVA, and multivariate logistic regression.
Main Results:
- Total cerebral venous volume positively correlated with head circumference but showed no significant difference between groups with and without intracranial hypertension.
- The intracranial hypertension group exhibited a significantly increased proportion of straight sinus (StrS) volume.
- Increased StrS volume was independently associated with a higher likelihood of intracranial hypertension.
Conclusions:
- Intracranial hypertension in sCS is not associated with a generalized increase in total cerebral venous volume.
- An isolated increase in straight sinus (StrS) volume is linked to intracranial hypertension in sCS.
- The findings suggest a localized venous issue or central cerebral vulnerability rather than widespread venous outflow obstruction.
Objective:
Intracranial hypertension is a major concern in children with syndromic craniosynostosis (sCS). Cerebral venous hypertension caused by cerebral venous outflow obstruction is believed to contribute to intracranial hypertension. The authors therefore hypothesized that cerebral venous volume would be increased in those children with sCS and intracranial hypertension.
Methods:
In a case series of 105 children with sCS, of whom 32 had intracranial hypertension, cerebral MRI techniques were used to quantify the volume of the superior sagittal sinus, straight sinus (StrS), and both transverse sinuses.
Results:
Linear regression showed that total cerebral venous volume increased by 580.8 mm3 per cm increase in occipitofrontal head circumference (p < 0.001). No significant difference was found between the intracranial hypertension group and the nonintracranial hypertension group (p = 0.470). Multivariate ANOVA showed increased StrS volume (as a proportion of total volume) in the intracranial hypertension group (8.5% vs 5.1% in the nonintracranial hypertension group, p < 0.001). Multivariate logistic regression showed that a 100-mm3 increase in StrS volume is associated with increased odds of having intracranial hypertension by 60% (OR 1.60, 95% CI 1.24-2.08).
Conclusions:
Although intracranial hypertension was not associated with total cerebral venous volume increase, it was associated with an isolated increase in StrS volume. Hence, it is unlikely that general cerebral venous outflow obstruction is the mechanism of intracranial hypertension in sCS. Rather, these findings indicate either a central cerebral vulnerability to intracranial hypertension or a mechanism involving venous blood redistribution.
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