title: Surgical techniques of cranial vault expansion for increases in intracranial pressure in older children.
abstract: Standard craniofacial techniques to expand the cranial vault were successful in treating elevations of intracranial pressure (ICP) in 7 older children. Of the 7 patients, a diagnosis of craniosynostosis was made in 6 and deformational head deformity with slit ventricle syndrome in 1. There were 5 boys and 2 girls, whose ages ranged from 3 1/2 to 8 years (mean, 5.2 yr). Three patients had previously undergone surgical treatment of craniosynostosis. One patient presented with visual changes and papilledema. Another with a deformational skull deformity was shunt-dependent and was diagnosed with slit ventricle syndrome. This patient had undergone several temporal craniectomies to control recurrent symptoms of increased ICP. The remaining 2 patients appeared to have craniosynostosis as an explanation for reduced cranial vault size and elevated ICP, but the specific sites of sutural fusion could not be identified. Total follow-up ranged from 3 to 18 months, and evidence of resolution of signs and symptoms of increased ICP was achieved in each of the 7 patients. Plastic surgeons involved in caring for children with craniosynostosis should be particularly aware of the possibility of increased ICP developing or recurring following craniofacial surgery.
authors.affiliation: Center for Craniofacial Disorders, Scottish Rite Children's Hospital, Atlanta, GA.
authors.forename: S R
authors.initials: SR
authors.lastname: Cohen
authors.forename: R C
authors.initials: RC
authors.lastname: Dauser
authors.forename: M H
authors.initials: MH
authors.lastname: Newman
authors.forename: K
authors.initials: K
authors.lastname: Muraszko
mesh_terms: D002552:Cerebral Ventricles / Q000002:abnormalities; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000150:complications / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005546:Forehead; D005624:Frontal Bone / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007427:Intracranial Pressure; D008297:Male; D009915:Orbit / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D010211:Papilledema / Q000209:etiology; D012008:Recurrence; D012086:Reoperation