SUBDURAL INTRACRANIAL-PRESSURE MONITORING IN CRANIOSYNOSTOSIS - ITS ROLE IN SURGICAL-MANAGEMENT

In the management of craniosynostosis subdural intracranial pressure ( ICP) monitoring has proved a useful and safe means of identifying thos e children with raised ICP who are at risk from its long-term sequelae and who would benefit from early surgical intervention. Overnight sub dural ICP recordings have been obtained in 136 unoperated cases of cra niosynostosis. Fifteen patients were studied both before and after cra nial vault remodelling procedures. ICP was raised (>15 mmHg) in 35%, b orderline (10-15 mmHg) in 37% and normal (<10 mmHg) in 27% of cases. R aised ICP was present in 28/53 of the syndromic craniofacial dysostosi s cases and in 20/ 83 non-syndromic craniosynostosis cases investigate d (P<0.001). Raised mean ICP and periodic plateaux of sustained ICP du ring sleep were particularly associated with the syndromic cases. Of t he 15 patients studied following cranial vault surgery, 9 showed a red uction in ICP, 3 were unchanged and 3 had higher ICP postoperatively. The results of ICP monitoring can contribute significantly to formulat ing a rational and staged surgical management plan incorporating the n eed to normalise ICP and correct the frequently severe functional and cosmetic consequences of these disorders.