ArticleChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2025
Utility of invasive intracranial pressure monitoring in children with craniosynostosis: relationship to clinical assessment, syndrome and surgical treatment.
Article in Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThis is a retrospective study investigating intracranial pressure monitoring (ICPM) as a tool for managing children with craniosynostosis. We report on our experience of chronic (≥24 hour) ICP measurement in patients with CS and related conditions, with the aim of statistically assessing the relationship between ICP and derived variables to clinically relevant patient characteristics, such as clinical/ophthalmological symptoms/signs, diagnosis, syndrome and surgical management.
methodsIt is a single-centre study following 32 patients who underwent ICP monitoring over 24-72 h. We collected a consecutive series of children (aged < 18 years) who underwent invasive ICPM between 1st Jan 2019 and 31st December 2021 from our institution's electronic surgical database. All patients had either craniosynostosis or foramen magnum pathology. We excluded children with non-CS diagnoses, except those with non-CS-related foramen magnum stenosis (FMS) who were used as comparative controls. Statistical analysis included the Kruskal-Wallis test to compare median ICP results between craniosynostosis and foramen magnum pathology, surgery vs non-surgical management, and differences in syndromic subgroups. A Spearman correlation was used to determine the relation of ICPM results to presentation symptoms.
resultsResults showed that patients who underwent surgery had a higher ICPM than those that did not. They also showed that patients with CS had higher ICP when compared to foramen magnum pathologies. Results also showed differences in pulse altitude (PA) in different subtypes of CS, although not statistically significant, and a mild correlation of PA with certain presenting symptoms of CS deterioration. DISCUSSION: In conclusion, our study shows that ICP and PA are safe and useful tools that can differentiate between craniosynostosis and similar pathology, as well as correlate to symptomatology. Furthermore, the data in this study can help us understand what a 'well' ICP is, in patients with various CS conditions, which differs from a "signature" raised ICP in patients close to decompensation. ICP can therefore be a valuable tool in surgical decision making, in conjunction with clinical correlation.
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