title: The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature.
abstract: OBJECTIVE
  The presence of raised intracranial pressure (ICP) in untreated nonsyndromic, isolated sagittal craniosynostosis (SC) is an important functional indication for surgery.
  
  
  METHODS
  A retrospective review was performed of all 284 patients presenting with SC to the Oxford Craniofacial Unit between 1995 and 2010.
  
  
  RESULTS
  Intraparenchymal ICP monitoring was performed in 39 children following a standard unit protocol. Monitoring of ICP was offered for all patients in whom nonoperative management was considered on the basis of minimal deformity or in cases in which parents were reluctant to agree to corrective surgery. These patients presented at an older age than the rest of the cohort (mean age 56 months), with marked scaphocephaly (16/39, 41%), mild scaphocephaly (11, 28%), or no scaphocephalic deformity (12, 31%). Raised ICP was found in 17 (44%) patients, with no significant difference in its incidence among the 3 different deformity types. Raised ICP was not predicted by the presence of symptoms of ICP or developmental delay or by ophthalmological or radiological findings.
  
  
  CONCLUSIONS
  The incidence of raised ICP in SC reported here is greater than that previously published in the literature. The lack of a reliable noninvasive method to identify individuals with elevated ICP in SC mandates consideration of intraparenchymal ICP monitoring in all patients for whom nonoperative management is contemplated.
authors.affiliation: Oxford Craniofacial Unit, Oxford University Hospitals National Health Service Trust, Oxford, United Kingdom.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Wall
authors.forename: Gregory P L
authors.initials: GP
authors.lastname: Thomas
authors.forename: David
authors.initials: D
authors.lastname: Johnson
authors.forename: Jo C
authors.initials: JC
authors.lastname: Byren
authors.forename: Jayaratnam
authors.initials: J
authors.lastname: Jayamohan
authors.forename: Shailendra A
authors.initials: SA
authors.lastname: Magdum
authors.forename: David J
authors.initials: DJ
authors.lastname: McAuley
authors.forename: Peter G
authors.initials: PG
authors.lastname: Richards
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D019586:Intracranial Hypertension / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D007427:Intracranial Pressure; D008297:Male; D057234:Preoperative Period; D012189:Retrospective Studies
keywords: ICP = intracranial pressure; SC = sagittal craniosynostosis; craniofacial; intracranial hypertension; intracranial pressure; sagittal craniosynostosis