title: Craniofacial reconstruction as a treatment for elevated intracranial pressure.
abstract: BACKGROUND
  Craniofacial procedures may be needed to address symptomatic intracranial hypertension. The authors review their institutional experience in the treatment of children with symptomatic increased intracranial pressure (ICP) utilizing craniofacial reconstructive procedures.
  
  
  METHODS
  The senior authors' (HSM, SRC) craniofacial experience of 222 patients over a 7-year period from 2000 to 2007 at a single institution (Rady Children's Hospital, San Diego) is reviewed. Seventeen patients were identified who were felt to be candidates for craniofacial surgery with symptomatic increased ICP.
  
  
  RESULTS
  Patient diagnoses included single-suture craniosynostosis, craniofacial dysostoses, shunt-induced craniostenosis, and shunt-associated intracranial hypertension (slit-ventricle syndrome). Seventeen patients underwent 21 craniofacial procedures. Age at surgery ranged from 3 months to 13 years with a mean of 5 years. Preoperative symptoms and signs included headaches, unexplained irritability, seizures, papilledema, and visual loss. All patients had diagnostic neuroimaging. Seven patients had preoperative invasive ICP measurements. Surgery was deferred on three of these patients based on these measurements. The mean total operative (including anesthetic preparation) and surgical times were 3 h 12 min and 2 h 20 min, respectively. Percentage operative blood loss averaged 11.3%. In six procedures, no transfusions were required. Average hospital stay was 4 days. There was no perioperative mortality or significant surgery associated morbidity. All patients have had postoperative clinical improvement in signs and symptoms of increased ICP.
  
  
  CONCLUSIONS
  Using modern diagnostic and surgical techniques, including invasive ICP monitoring, increased intracranial pressure can be successfully managed by an experienced, multidisciplinary, craniofacial team. Our treatment paradigm and operative management scheme is discussed.
authors: Division of Neurosurgery, University of California at San Diego, San Diego, CA, USA. lissa.baird@childrens.harvard.edu
authors: Lissa C
authors: LC
authors: Baird
authors: David
authors: D
authors: Gonda
authors: Steven R
authors: SR
authors: Cohen
authors: Lars H
authors: LH
authors: Evers
authors: Nathalie
authors: N
authors: LeFloch
authors: Michael L
authors: ML
authors: Levy
authors: Hal S
authors: HS
authors: Meltzer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003394:Craniofacial Dysostosis / Q000601:surgery; D003398:Craniosynostoses / Q000150:complications / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D005147:Facial Bones / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000150:complications / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome