title: Abnormal transcranial Doppler cerebral blood flow velocity and blood pressure profiles in children with syndromic craniosynostosis and papilledema.
abstract: OBJECTIVE
  Children with syndromic craniosynostosis are at risk of intracranial hypertension. This study aims to examine patient profiles of transcranial Doppler (TCD) cerebral blood flow velocity (CBFv) and systemic blood pressure (BP) in subjects with and without papilledema at the time of surgery, and subsequent effect of cranial vault expansion.
  
  
  METHODS
  Prospective study of patients treated at a national referral center. Patients underwent TCD of the middle cerebral artery 1 day before and 3 weeks after surgery. Measurements included mean CBFv, peak systolic velocity, and end diastolic velocity; age-corrected resistive index (RI) was calculated. Systemic BP was recorded. Papilledema was used to indicate intracranial hypertension.
  
  
  RESULTS
  Twelve patients (mean age 3.1 years, range 0.4-9.5) underwent TCD; 6 subjects had papilledema. Pre-operatively, patients with papilledema, in comparison to those without, had higher TCD values, RI, and BP (all p = 0.04); post-operatively, the distinction regarding BP remained (p = 0.04). There is a significant effect of time following vault surgery with a decrease in RI (p < 0.01).
  
  
  CONCLUSIONS
  Patients with syndromic craniosynostosis who have papilledema have a different TCD profile with raised BP. Vault surgery results in increased CBFv and decrease in RI, however the associated systemic BP response to intracranial hypertension remained at short-term follow-up.
authors: Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, The Netherlands. Electronic address: b.spruijt@erasmusmc.nl.
authors: B
authors: B
authors: Spruijt
authors: Harvard Medical School and Boston Children's Hospital, Departments of Neurology and Anaesthesia (Pediatrics), Boston, MA, USA.
authors: R C
authors: RC
authors: Tasker
authors: Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, The Netherlands.
authors: C
authors: C
authors: Driessen
authors: Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Department of Radiology, The Netherlands.
authors: M H
authors: MH
authors: Lequin
authors: Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Department of Neurosurgery, The Netherlands.
authors: M L C
authors: ML
authors: van Veelen
authors: Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, The Netherlands.
authors: I M J
authors: IM
authors: Mathijssen
authors: Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Pediatric Intensive Care Unit, The Netherlands.
authors: K F M
authors: KF
authors: Joosten
mesh_terms: D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D006801:Humans; D007223:Infant; D010211:Papilledema / Q000601:surgery*; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial
keywords: Craniosynostosis; Intracranial hypertension; Transcranial Doppler