Intracranial Hypertension

Intracranial hypertension (IH) is a very serious problem that is created when the pressure that the scull or cerebrospinal fluid (a clear fluid that is produced in the cavities of the scull) exerts in the cranial cavity is increased (or is too high).

CAUSES

The main causes in craniofacial abnormalities are the following:

  • Reduced capacity of the skull to grow (total or local only) due to craniosynostoses, during the period of brain development.
  • Impaired physiological bloodstream or cerebrospinal fluid in the cranial cavity.
  • Reduced venous blood lead (intracranial venous hypertension).
  • The obstructive sleep apnea contributes to increased intracranial pressure.

Other causes that are not related to craniofacial abnormalities are the following:

  • Traumatic brain injuries (TBI)
  • Cerebral hemorrhage
  • Brain tumors, etc

FUNCTIONAL DISORDERS

The prolonged presence of increased intracranial pressure may cause

  • Decrease or/and vision loss 
  • Cephalalgias (headaches)
  • Reduction of brain oxygenation (due to exerting pressure from the skull locally in the region of craniosynostosis). As a consequence of this, it is likely not to be able for the synapses to be created between brain cells that are necessary for normal brain development

The rapid rise of intracranial pressure (such for instance, in traumatic brain injuries) can cause death.

HOW IS DIAGNOSIS MADE

The diagnosis may be made according to the following:

  • With physical examination (ophthalmological findings such as papilledema as well as neurological findings).
  • From the findings of imaging examinations: in a CT may be a thinning of the skull bones – with the appearance of "wrought copper".
  • From the MRI, it may be determined the displacement downwardly of the lower part of the central nervous system – tonsils - or/and increase of the cerebral ventricles size).

Appearance of "wrought copper" due to intracranial hypertensionSide view

Immediate diagnosis is made by measuring of pressure; in the operating room by placing a special sensor in the cranial cavity.

For the above reasons, in the craniosynostoses (simple or syndromic), it is required regular ophthalmological examination. 

It is therefore obvious that children with craniosynostoses should be kept under continuous follow-up by the craniofacial team.

SURGICAL TREATMENT OF INTRACRANIAL HYPERTENSION

The surgical treatment of intracranial hypertension depends on the causes that create it and the findings in this case. If it is caused due to reduced cranial volume or to locally increased pressure from cranial pathology, it becomes cerebral decompression with surgical enlargement of the skull and correction of its shape.

  • If tonsils project downwardly, it may need to be surgically enlarged the foramen (hole) through which the spinal cord exits from the skull.
  • If the size of the brain cavities (ventricles) has been increased then it may need to be placed a valve for the drainage of the cerebrospinal fluid.
  • Finally, if there is obstructive sleep apnea then it should definitely be released the breath with minor surgeries such as tonsillectomy and adenoidectomy (adenoids) at an early age (these surgeries are not usually quite effective), or facial advancement (frontofacial advancement) which constitutes the only effective solution at a somewhat older age.

FOLLOW-UP

The intracranial hypertension, even if it is treated successfully, it may recrudesce. For this reason, children who have experienced this problem should necessarily be followed-up with regular ophthalmological and neurological exams, and at the discretion of the neurologist or neurosurgeon with MRIs.