The use of transcranial doppler for demonstrating intracranial hypertension in children with scaphocephaly

The aim: Chronic intracranial hypertension is present with the prevalence of 30-40% in syndrome craniosynostoses, of 12-20% in monosynostoses. This study aim was to establish whether there exists relation between the values of lumbar cerebrospinal fluid pressure in children with scaphocephaly and flow indices at the examinations using transcranial doppler sonography (TCD), and to compare pre- and postoperative results of TCD investigations. Method: Twenty-two children with scaphocephaly underwent, besides routine pre-operative examinations, the manometric measurements of the lumbar liquor pressures and TCD investigation that was repeated 7-8 days after the surgery. A paired t-test was used for the comparison of pre- and post-operative flow indices. Spearman's correlation coefficient was applied for establishing the correlation of the lumbar pressure values and TCD flow indices. Results: Neither brain CT nor cranial roentgenograms showed pre-operative signs of chronic intracranial hypertension. In 17 ouf ot 22 children (77%), the measured values of the lumbar liquor pressure were above the norm. Good cosmetic effects were obtained in all the subjects operated on. The flow indices of TCD were without significant differences at pre- as well as post-operative examinations. Conclusion: Some patients with scaphocephaly suffer from increased intracranial pressure. Remodelling surgeries for scaphocephaly also provide, besides esthetic effects, prevention from negative consequences of intracranial hypertension. TCD did not prove to be a sufficiently sensitive method for the demonstration of intracranial hypertension.