Intracranial hypertension after cranial vault decompression for craniosynostosis.
A 3-year-old boy with chronic papilledema, bilateral coronal synostosis and Pfeiffer syndrome underwent an orbitofrontal advancement. One month postoperatively, his papilledema had resolved, however, his vision progressively deteriorated over the ensuing 3 months to legal blindness. He had no symptoms or signs of increased pressure. Multiple imaging studies were unremarkable except for dilatation of the optic nerve sheaths. A lumbar puncture revealed intracranial hypertension, which resolved after treatment with a lumboperitoneal shunt. Intracranial hypertension may persist after craniofacial reconstruction. In patients who have progressive neurological deterioration after craniofacial reconstruction, direct measurement of intracranial pressure is indicated, despite a lack of clinical signs or symptoms of intracranial hypertension and normal imaging studies.
Campbell
J W
JW
Department of Neurosurgery, Children's Hospital of Pittsburgh, Penn., USA.
Albright
A L
AL
Losken
H W
HW
Biglan
A W
AW
D002675:Child, Preschool; D003398:Craniosynostoses / Q000150:complications / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007427:Intracranial Pressure; D008297:Male; D009900:Optic Nerve / Q000503:physiopathology; D010211:Papilledema / Q000150:complications; D012886:Skull / Q000601:surgery*; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity