The Use of Transcranial Doppler for Demonstrating Intracranial Hypertension in Children with Scaphocephaly

Authors: D. Hoza 1;  D. Hořínek;  M. Tichý 1;  Z. Novák 3;  M. Vaculík 1;  A. Tomek 4;  J. Blažková 5;  I. Škodová 1;  J. Hort 4;  M. Šrámek 4;  H. Krásničanová 6
Authors‘ workplace: Odd. dětské neurochirugie, FN v Motole, Praha 1;  Ústav patologické fyziologie 2. LF UK, Praha 2;  Neurochirurgická klinika, FN U sv. Anny, Brno 3;  Neurologická klinika 2. LF UK4, Praha 4;  Klinika anesteziologie a resuscitace 2. LF UK, Praha 5;  Antropologická laboratoř Pediatrické kliniky 2. LF UK, Praha 6
Published in: Cesk Slov Neurol N 2007; 70/103(1): 43-48
Category: Original Paper

Práce byla podpořena grantem IGA NR/8264-3.


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.

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.

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.

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.

Key words:
scaphocephaly – intracranial hypertension – lumbar cerebrospinal fluid pressure – transcranial hypertension – lumbar liquor


1. Kaufman BA, Muszynski CA, Matthews A, Etter N. The circle of sagittal synostosis surgery. Semin Pediatr Nurol 2004; 11: 243-8.

2. Renier D, Sainte-Rose C, Marchac D, Hirsch J. Intracranial pressure in craniostenosis. J Neurosurg 1982; 57: 370-7.

3. Tuite GF Evanson J, Chong WK, Thompson DNP, Harkness WF, Jones BM. The beaten copper cranium: a correlation between intracranial pressure, cranial radiographs, and computed tomographic scans in children with craniosynostosis. Neurosurgery 1996; 39: 691-9.

4. Jensen RL, Hahn YS, Ciro E. Risk factors of intracranial monitoring of intracraial pressure. II. Comparative study and initial assesment. Surg Neurol 1997; 47: 16-22.

5. Gambardella G, Zaccone C, Cardia E, Tomasello F. Intracranial pressure monitoring in children: comparison of external ventricular device with the fibreoptic system. Childs Nerv Syst 1993; 9: 470-3.

6. Morgalla MH, Cuno M, Mettenleiter H, Will BE, Krasznai L, Skalej M et al. ICP monitoring with a re-usable transducer: experimental and clinical evlauation of Gaeltec ICT/b pressure probe. Acta Neurochir (Wien) 1997; 139: 569-73.

7. Munch E, Weigel R, Schmidek P, Schurer L. The Camino intracranial pressure device in clinical practise: reliability, handling characteristics and complicactions. Acta Neurochir (Wien) 1998; 140: 1113-20.

8. Blaha M, Lazar D, Winn RH, Ghatan S. Hemorrhagic complications of intracranial pressure monitors in children. Pediatric Neurosurgery 2003; 39: 27-31.

9. Lindegaard KF, Bakke SJ, Seslic R, Bornea H. Doppler diagnosis of intracranial artery occlusive disoreders. J Neurol Neurosurg Psychiatry 1986; 49: 510-18.

10. Hennerici M, Rautenberg W, Schwartz A. Transcranial Doppler ultrasound for the assesment of intracranial arterial flow velocity. Part 2: evaluation intracranial arterial disease. Surg Neurol 1987; 27: 523-32.

11. Rainov NG, Weise JB, Burkert W. Transcranial Doppler sonography in adult hydrocephalic patients. Neurosurg Rev 2000; 23: 34-8.

12. Bode H, Wais U. Age dependence on flow velocities in basal cerebral arteries. Arch Dis Child 1988; 63: 606-11.

13. Blaha M, Aaslid R, Douville CM, Correra R, Newell DW. Cerebral blood flow and dynamic cerebral autoregulation during ethanol intoxication and hypercapnia. J Clin Neurosci 2003; 10: 195-8.

14. Markwalder TM, Grolimund P, Seiler RW, Roth F, Aaslid R. Dependency of blood flow velocity in the middle cerebral artery on end-tidal carbon dioxide partial pressure - a transcranial ultrasound Doppler study. J Cereb Blood Flow Metab 1984; 4: 368-72.

15. Fok H, Jones BM, Gault DG, Andar U, Hayward R. Realtionship between intracranial pressure and intracranial volume in craniosynostosis. Br J Plast Surg 1992; 45: 394-7.

16. Gault DT, Renier D, Marchac D, Jones BM. Intracranial pressure and intracranial volume in children with craniosynostosis. Plast Reconstr Surg 1992; 90: 377-81.

17. Taylor WJ, Hayward RD, Lasjaunias P, Britto JA, Thompson DNP, Jones BM et al. Enigma of raised intracranial pressure in patients with complex craniosynostosis: the role of abnormal intracranial venous drainage. J Neurosurg 2001; 94: 377–85.

18. Sgouros S, Goldin JH, Hockley AD, Wake MJC, Natarajan K. Intracranial volume change in childhood. J Neurosurg 1999; 91: 610–16.

19. Hassler W, Zentner J. Radical osteoclastic craniectomy in sagittal synostosis. Neurosurgery 1990; 27: 539-43.

20. Chadduck WM, Chadduck JB, Boop FA. The subarachnoid spaces in craniosynostosis. Neurosurgery 1992; 30: 867-71.

21. Minns RA. Intracranial pressure monitoring. Arch Dis Child 1984; 59: 486-8.

22. Jensen RL, Hahn YS, Ciro E. Risk factors of intracranial presure monitoring in children with fibreoptic devices: a critical review. Surg Neurol 1997; 47: 16-22.

23. Thompson DNP, Harkness W, Jones BM, Gonzales S, Andar U, Hayward R. Subdural intracranial pressure monitoring in craniosynostosis: its role in surgical managment. Childs Nerv System 1995; 11: 269-75.

24. Eide PK, Helseth E, Due-Tonnessen B, Lundar T. Changes in intracranial pressure after calvarial expansion surgery in children with slit ventricle syndrome. Pediatr Neurosurg 2001; 35: 195-204.

25. Gambardell G, Zaccone C, Cardia E, Tomasello F. Intracranial pressure monitoring in children: comparison of external ventricular device with the fibreoptic system. Childs Nerv Syst 1993; 9: 470-3.

26. Pople IK, Muhlbauer MS, Sanford RA, Kirk E. Results and complications of intracranial pressur monitoring in 103 children. Pediatr Neurosurg 1995; 23: 64-7.

27. Eide PK, Fremming AD. A computer-based method for comparisons of continuous intracranial pressure recordings within individual cases. Acta Neurochir 2003; 145: 351-8.

28. Tuite GF, Chong WK, Evanson J, Narita A, Taylor D, Harkness WF et al. The effectiveness of papilledema as an indicator of raised intracranial pressure in children with craniosynostosis. Neurosurgery. 1996; 38: 272-8.

29. Eide PK, Helseth E, Tonnessen B, Triggve L. Assesment of continuous intracranial pressure recordings in childhood craniosynostosis. Pediatr Neurosurg 2002; 37: 310-20.

30. Thompson DNP, Malcom GP, Jones BM, Harkenss WJ, Hayward RD. Intracranial pressure in single suture craniosynostosis. Pediatr Neurosurg 1995; 22: 235-40.

31. Renier D. Intracranial pressure in craniosynostosis: pre and postoperative recordings – correlation with functional results. In: Persing JA, Edgerton MT, Jane J, editors. Scientific foundations and surgical treatment of craniosyostosis. Williams and Wilkins 1989: 263-9.

32. Sgouros S. Skull vault growth in craniosynostosis. Childs Nerv Syst 2005; 21: 861-70.

33. Siddiqui S, Posnick JC, Buncic R, Humphreys RP, Hoffman HJ, Drake JM et al. The detection and managment of intracranial hypertension after initial suture release and decompression for craniofacial dysostosis syndromes. Neurosurgery 1995; 36: 703-9.

34. Iqbal JB, Hockley AD, Wake MJ, Goldin JH. Transcranial Doppler sonography in craniosynostosis. Childs Nerv Syst 1994; 10: 259-63.

35. Rifkinson-Mann S, Goraj B, Leslie D, Visitainer PF, Pandua HM Jr. Transcranial Doppler analysis of cerebral hemodynamics in primary craniosynostosis: study in progress. Surg Neurol 1995; 44: 334-7.

36. Govender PV, Nadvi SS, Madaree A. The value of transcranial Doppler ultrasosnography in craniosynostosis. J Craniofac Surg 1999; 10: 260-3. 37. Westra SJ, Stotland MA, Lazareff J, Anderson CT, Sayre JW, Kawamoto H. Perioperative transcranial Doppler US to evaluate intracranial compliance in young children undergoing craniosynostosis repair surgery. Radiology 2001; 218: 816-23. 38. Nakatani S, Ozaki K, Hara K. Simultaneous Monitoring of ICP and Trascranial Doppler Sonogram on the Middle Cerebral Artery. In: Miller JD, Hoff JT, Betz AL, editors. Intracranial Pressure VII. Berlin-Heidelberg: Springer 1989: 113-5. 39. Aaslid R, Lundar T, Lindegaard K-F. Estimation of Cerebral Perfusion Pressure from Arterial Blood Pressure and Transcranial Doppler Recordings. In: Miller JD, Teasdale GM, Rowan JO (eds). Intracranial Pressure VI. Berlin-Heidelberg: Springer 1986: 226-9.

40. Chadduck WM, Crabtree HM, Blankenship JB, Adametz J. Transcranial Doppler ultrasonography for the evaluation of shunt mlfunction in pediatric patients. Childs Nerv Syst 1991; 7: 27-30.

41. Klingelhöfer J, Conrad B, Benecke R, Bencke R, Sander D, Markakis E. Evaluation of intracranial pressure from transcranial Doppler studies in cerebral disease. J Neurol 1988; 235: 159-62.

42. Klingelhöfer J, Sander D, Holzgraefe M, Bischoff C, Conrad B. Cerebral vasospasm evaluated by transcranial Doppler ultrasonography at different inntracranial pressures. J Neurosurg 1991; 75: 752-8.

43. Quinn MW, Pople IK. Middle cerebral artery pulsatility in children with blocked cerebrospinal fluid shunts. J Neurol Neurosurg Psychiatry 1992; 55: 595-603.

44. Babikian VL, Wechsler RL, Toole FJ. Transcranial Doppler Ultrasonography. 2nd ed. Butterworth-Heinemann; 1999.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 1

2007 Issue 1

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account