Delayed intracranial hypertension after cranial vault remodeling for nonsyndromic single-suture synostosis.

OBJECT Delayed intracranial hypertension may occur after cranial vault remodeling for synostosis and may result in visual loss and developmental delay. Delayed intracranial hypertension is relatively common in children with syndromic, multisuture synostosis, but the incidence is poorly defined in children with single-suture nonsyndromic synostosis. This study evaluates the frequency of reoperation for delayed intracranial hypertension after single-suture synostosis repair. METHODS Patients who had undergone cranial vault remodeling for nonsyndromic single-suture synostosis and were treated at a single tertiary pediatric hospital between July 2000 and December 2010 were analyzed for the occurrence of delayed intracranial hypertension and reoperation for cranial vault remodeling. RESULTS Eighty-one patients with clinical follow-up of at least 3 years were analyzed from a total of 156 consecutive patients. The average patient age at the initial operation was 9.1 months. Five (6.2%) of 81 patients presented with delayed clinical and ophthalmological signs and symptoms of intracranial hypertension following initial cranial vault reconstruction, confirmed indirectly in each case by CT findings and directly by intracranial pressure monitoring. These 5 patients underwent repeat cranial vault reconstruction. CONCLUSIONS Calvarial growth restriction and intracranial hypertension occur sporadically following primary cranial vault reconstruction for single-suture nonsyndromic cranial synostosis. In this series, delayed intracranial hypertension occurred only in male patients who underwent primary repair of isolated sagittal synostoses at an age less than or equal to 5 months.

[1]  N. Selden,et al.  Decreasing the effective radiation dose in pediatric craniofacial CT by changing head position , 2010, Pediatric Radiology.

[2]  I. Pollack,et al.  A single-center experience with symptomatic postoperative calvarial growth restriction after extended strip craniectomy for sagittal craniosynostosis. , 2010, Journal of neurosurgery. Pediatrics.

[3]  É. Arnaud,et al.  Scaphocephaly Part II: Secondary Coronal Synostosis After Scaphocephalic Surgical Correction , 2009, The Journal of craniofacial surgery.

[4]  D. Marucci,et al.  Implications of a Vertex Bulge following Modified Strip Craniectomy for Sagittal Synostosis , 2008, Plastic and reconstructive surgery.

[5]  D. Frim,et al.  Recurrence of Synostosis following Surgical Repair of Craniosynostosis , 2008, Plastic and reconstructive surgery.

[6]  J. Persing,et al.  Intracranial Volume and Cephalic Index Outcomes for Total Calvarial Reconstruction among Nonsyndromic Sagittal Synostosis Patients , 2008, Plastic and reconstructive surgery.

[7]  Atul Kumar,et al.  The optic nerve in children with craniosynostosis , 1993, Documenta Ophthalmologica.

[8]  A. Hockley,et al.  Intracranial volume change in craniosynostosis. , 1999, Journal of neurosurgery.

[9]  S. R. Cohen,et al.  Multiple suture synostosis and increased intracranial pressure following repair of single suture, nonsyndromal craniosynostosis. , 1998, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[10]  P. Stavrou,et al.  Visual failure caused by raised intracranial pressure in craniosynostosis , 1997, Child's Nervous System.

[11]  B. Shultz,et al.  Long-term outcome after sagittal synostosis operations. , 1996, Pediatric neurosurgery.

[12]  A. Wilkie.  Fibroblast growth factor receptor mutations and craniosynostosis: Three receptors, five syndromes , 1996, Indian journal of pediatrics.

[13]  W. Harkness,et al.  The Effectiveness of Papilledema as an Indicator of Raised Intracranial Pressure in Children with Craniosynostosis , 1996 .

[14]  B H Grayson,et al.  Twenty‐Year Experience with Early Surgery for Craniosynostosis: I. Isolated Craniofacial Synostosis—Results and Unsolved Problems , 1995, Plastic and reconstructive surgery.

[15]  U. Bite,et al.  Metopic and Sagittal Synostosis: Intracranial Volume Measurements Prior to and After Cranio‐Orbital Reshaping in Childhood , 1995, Plastic and reconstructive surgery.

[16]  J. Drake,et al.  The detection and management of intracranial hypertension after initial suture release and decompression for craniofacial dysostosis syndromes. , 1995, Neurosurgery.

[17]  M. Eccles,et al.  Jackson-Weiss and Crouzon syndromes are allelic with mutations in fibroblast growth factor receptor 2 , 1994, Nature Genetics.

[18]  Sue Malcolm,et al.  Mutations in the fibroblast growth factor receptor 2 gene cause Crouzon syndrome , 1994, Nature Genetics.

[19]  A. Hockley,et al.  Fronto-orbital re-operation in craniosynostosis. , 1994, British journal of plastic surgery.

[20]  T. Ozgen,et al.  Craniosynostosis: a review of 143 surgically-treated cases. , 1992, The Turkish journal of pediatrics.

[21]  S. Newman.  Ophthalmic features of craniosynostosis. , 1991, Neurosurgery clinics of North America.

[22]  D. Rénier,et al.  Intracranial Volume in Children With Craniosynostosis , 1990, The Journal of craniofacial surgery.

[23]  D. Rénier,et al.  Craniofacial surgery for craniosynostosis: functional and morphological results. , 1988, Annals of the Academy of Medicine, Singapore.

[24]  S. Bartlett,et al.  Craniosynostosis: an analysis of the timing, treatment, and complications in 164 consecutive patients. , 1987, Plastic and reconstructive surgery.

[25]  D. Rénier,et al.  [Ophthalmologic complications of craniofacial stenoses. Apropos of 244 cases]. , 1986, Journal francais d'ophtalmologie.

[26]  J. Hirsch,et al.  Intracranial pressure in craniostenosis. , 1982, Journal of neurosurgery.