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Craniosynostosis Surgery for Increased Intracranial Pressure
Megan E H Still1, Shreya Chidarala2, Abraham Alvarado1
1University of Florida, Lillian S. Wells Department of Neurosurgery.
Insights
Craniosynostosis surgery improves symptoms of increased intracranial pressure (ICP), particularly in older children. Classic ICP signs like papilledema and headache showed the most improvement after surgical repair.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Biology
Background:
- Craniosynostosis involves premature fusion of cranial sutures, potentially leading to increased intracranial pressure (ICP).
- The response of ICP symptoms to surgical treatment for craniosynostosis can vary.
- Identifying specific symptoms that improve post-surgery is crucial for treatment planning.
Purpose of the Study:
- To identify signs and symptoms of increased ICP in craniosynostosis patients that are most likely to resolve after surgical intervention.
- To correlate patient age and specific clinical features with postoperative symptom improvement.
Main Methods:
- Retrospective analysis of 153 craniosynostosis patients (syndromic and non-syndromic) from January 2009 to June 2020.
- Evaluation of preoperative and postoperative data, including demographics, symptoms (headache, nausea, lethargy), and signs (papilledema, visual disturbances).
- Statistical analysis to determine correlations between patient characteristics, preoperative symptoms, and postoperative outcomes.
Main Results:
- Fifty-six patients with preoperative symptoms met inclusion criteria.
- Older age at surgery was significantly associated with a greater number of improved symptoms (P=0.015).
- Papilledema, headache, nausea, and irritability were the most frequently improved symptoms; optic nerve anomalies and feeding difficulties were least likely to improve.
Conclusions:
- Older children with craniosynostosis generally experience more symptom improvement after surgery.
- Classical signs of increased ICP are more responsive to surgical repair than developmental issues.
- These findings aid in surgical decision-making for symptomatic craniosynostosis patients.
Introduction:
Craniosynostosis is the premature fusion of 1 or more cranial sutures. The presentation may vary, and there are differing opinions regarding surgical indications and timing. Though increased intracranial pressure (ICP) is a well-established risk of craniosynostosis, its response to treatment is not uniform. This study aims to identify the signs and symptoms indicative of increased ICP that are most likely to improve after craniosynostosis surgery.
Methods:
Pre- and post-operative data were retrospectively collected from patients at our institution with syndromic and non-syndromic craniosynostosis from January 2009 to June 2020. Demographics, symptoms (headache, nausea, emesis, and lethargy), signs (visual disturbances and papilledema), and imaging characteristics (copper beaten changes), if available, were analyzed.
Results:
One hundred fifty-three children with craniosynostosis were identified, and 56 with preoperative symptoms met inclusion criteria. Older age was significantly correlated with the number of symptoms improved postoperatively ( P = 0.015). Papilledema, headache, nausea, and irritability (if present preoperatively) were the features most likely to improve after craniosynostosis repair. Optic nerve or disc anomalies, feeding difficulties, seizures, and need for glasses were least likely to improve.
Conclusions:
Older children undergoing craniosynostosis surgery had a greater number of improved symptoms. Classical features of increased ICP were more likely to improve than developmental difficulties and multifactorial causes. These findings may be useful when considering craniosynostosis repair in a symptomatic child.
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