THE BEATEN COPPER CRANIUM - A CORRELATION BETWEEN INTRACRANIAL-PRESSURE, CRANIAL RADIOGRAPHS, AND COMPUTED TOMOGRAPHIC SCANS IN CHILDREN WITH CRANIOSYNOSTOSIS

OBJECTIVE: The beaten copper appearance of the cranium, as well as oth er cranial radiographic and computed tomographic findings in children with craniosynostosis, is often interpreted by clinicians as evidence of elevated intracranial pressure (ICP). However, a correlation betwee n radiological findings and ICP measurements has not been previously d emonstrated, and their usefulness in detecting elevated ICP has not be en defined. METHODS: To address those issues, 123 children with cranio synostosis who had cranial radiographs and ICP monitoring were studied . To assess the specificity of certain radiological findings to patien ts with craniosynostosis, cranial radiographs of patients with cranios ynostosis were compared to those of age- and sex-matched controls. In patients with craniosynostosis, findings on cranial radiographs were c ompared to computed tomographic scans of the brain. Radiographic findi ngs were then correlated with ICP measurements obtained while the pati ent was sleeping, which was measured using a Camino fiberoptic ICP mon itor (Camino Laboratories, San Diego, CA). All radiographs were indepe ndently analyzed by two radiologists who were blinded to clinical and ICP data. RESULTS: A diffuse beaten copper pattern, erosion of the dor sum sella, and suture diastasis were seen more commonly in patients wi th craniosynostosis than in controls (P <0.05), but the presence of th e beaten copper pattern was no more common in children with craniosyno stosis. ICP was greater when a diffuse beaten copper pattern, dorsum s ellar erosion, suture diastasis, or narrowing of basal cisterns was pr esent (P <0.05). CONCLUSION: Although this study demonstrates that som e cranial radiographic and computed tomographic findings do correlate with elevated ICP, the sensitivity of radiological methods for detecti ng elevated ICP is universally low and they are not recommended to scr een for elevated ICP in children with craniosynostosis.