Delayed intracranial hypertension after surgery for nonsyndromic craniosynostosis. S Lam, KM Wagner, E Middlebrook, TG. Luerssen.
Date: December 2015
Source: Surgical Neurology International. 2015; 6: 187.
Case Example: A 2-month-old boy presented with an elongated (anterior-posterior) head shape, prominent wide forehead, and bitemporal narrowing. There was a visible and palpable bony keel along the sagittal suture that was present since birth. He was the first child in the family, born at 40 weeks’ gestation, with no other obstetric, perinatal, or family history. His parents wished to pursue surgical correction of the sagittal synostosis, which he underwent with an unremarkable postoperative course. He continued to be followed annually as he enrolled in school. His parents have asked about the chances of requiring another surgery.
In practice: At Texas Children’s Hospital, we have a dedicated multidisciplinary craniosynostosis surgery program, where care is integrated for patients and families. Multidisciplinary care includes neurosurgery, plastic surgery, social work, neuropsychology, developmental pediatrics, otolaryngology, and ophthalmology involvement. We follow patients postoperatively on an annual basis until they reach their teenage years. Cetas et al. have recommended screening until the child is at least 6 years old. We extend this time frame further to follow long-term outcomes. In addition to clinical assessment and tracking of head circumference growth, research quantification of morphometric and volumetric outcomes includes two-dimensional laser surface scanning, traditional photographs, and three-dimensional “3DMD” photographs with volumetric reconstructions. We aim to minimize radiation exposure through CT unless clinically indicated, so CT scanning is not part of our routine follow-up in the absence of symptoms. Fundoscopic exam is performed to assess for papilledema, a sign that becomes increasingly useful to elevated ICP as the child ages. As no one sign or symptom is 100% sensitive and specific for detecting elevated ICP, a multidisciplinary approach is essential. In addition, monitoring neuropsychological development can help detect cognitive difficulties if present, and our program can help families arrange for appropriate social and educational support services.
Article: Delayed intracranial hypertension after surgery for nonsyndromic craniosynostosis.
Authors: Sandi Lam, Kathryn M. Wagner, Emily Middlebrook, and Thomas G. Luerssen. Department of Neurosurgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA.