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01-06-2018 | Case-Based Update

Cranial morcellation decompression for refractory idiopathic intracranial hypertension in children

Authors: Matheus Fernando Manzolli Ballestero, Thiago Lyrio Teixeira, Lucas Pires Augusto, Stephanie Naomi Funo de Souza, Marcelo Volpon Santos, Ricardo Santos de Oliveira

Published in: Child's Nervous System | Issue 6/2018

Abstract

Background

Primary idiopathic intracranial hypertension (PIIH) in children is rare and has a poorly understood pathophysiology. It is characterized by raised intracranial pressure (ICP) in the absence of an identified brain lesion. Diagnosis is usually confirmed by the measurement of a high cerebrospinal fluid (CSF) opening pressure and exclusion of secondary causes of intracranial hypertension. Refractory PIIH may lead to severe visual impairment. The purpose of this study was to evaluate a cranial morcellation decompression (CMD) technique as a new surgical alternative to stabilize intracranial pressure in PIIH.

Materials and methods

A literature review was carried out, disclosing only 7 pediatric cases of PIIH treated with surgical skull expansion. In addition, we describe here one case of our own experience treated by CMD.

Conclusions

CMD surgery is a safe and effective option to control refractory PIIH in selected patients.

Abubaker K, Ali Z, Raza K, Bolger C, Rawluk D, O'Brien D (2011) Idiopathic intracranial hypertension: lumboperitoneal shunts versus ventriculoperitoneal shunts—case series and literature review. Br J Neurosurg 25:94–99. https://doi.org/10.3109/02688697.2010.544781 CrossRefPubMed

Aiken AH, Hoots JA, Saindane AM, Hudgins PA (2012) Incidence of cerebellar tonsillar ectopia in idiopathic intracranial hypertension: a mimic of the Chiari I malformation. AJNR Am J Neuroradiol 33:1901–1906. https://doi.org/10.3174/ajnr.A3068 CrossRefPubMed

Ball AK, Clarke CE (2006) Idiopathic intracranial hypertension. The Lancet Neurology 5:433–442. https://doi.org/10.1016/S1474-4422(06)70442-2 CrossRefPubMed

Binder DK, Horton JC, Lawton MT, McDermott MW (2004) Idiopathic intracranial hypertension. Neurosurgery 54:538–551 discussion 551-532CrossRefPubMed

Bursztyn LL, Sharan S, Walsh L, LaRoche GR, Robitaille J, De Becker I (2014) Has rising pediatric obesity increased the incidence of idiopathic intracranial hypertension in children? Canadian journal of ophthalmology Journal canadien d'ophtalmologie 49:87–91. https://doi.org/10.1016/j.jcjo.2013.09.015 CrossRefPubMed

Corbett JJ, Mehta MP (1983) Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumor cerebri. Neurology 33:1386–1388CrossRefPubMed

Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, Hopson D (1982) Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol 39:461–474CrossRefPubMed

Corbett JJ, Thompson HS (1989) The rational management of idiopathic intracranial hypertension. Arch Neurol 46:1049–1051CrossRefPubMed

Dandy WE (1937) Intracranial pressure without brain tumor: diagnosis and treatment. Ann Surg 106:492–513CrossRefPubMedPubMedCentral

10.

Donaldson JO (1981) Pathogenesis of pseudotumor cerebri syndromes. Neurology 31:877–880CrossRefPubMed

11.

Ellis JA, Anderson RC, O'Hanlon J, Goodman RR, Feldstein NA, Ghatan S (2012) Internal cranial expansion surgery for the treatment of refractory idiopathic intracranial hypertension. J Neurosurg Pediatr 10:14–20. https://doi.org/10.3171/2012.3.peds11228 CrossRefPubMed

12.

Farb R, Vanek I, Scott J, Mikulis D, Willinsky R, Tomlinson G (2003) Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 60:1418–1424CrossRefPubMed

13.

Foley J (1955) Benign forms of intracranial hypertension “toxic” and “otitic” hydrocephalus. Brain 78:1–41. https://doi.org/10.1093/brain/78.1.1 CrossRefPubMed

14.

Gideon P, Thomsen C, St F, Gjerris F, Henriksen O (1995) Increased brain water self-diffusion in patients with idiopathic intracranial hypertension. Am J Neuroradiol 16:381–387PubMed

15.

Gillson N, Jones C, Reem RE, Rogers DL, Zumberge N, Aylward SC (2017) Incidence and demographics of pediatric intracranial hypertension. Pediatr Neurol 73:42–47. https://doi.org/10.1016/j.pediatrneurol.2017.04.021 CrossRefPubMed

16.

Gordon K (1997) Pediatric pseudotumor cerebri: descriptive epidemiology. The Canadian journal of neurological sciences Le journal canadien des sciences neurologiques 24:219–221CrossRefPubMed

17.

Greene CS Jr, Winston KR (1988) Treatment of scaphocephaly with sagittal craniectomy and biparietal morcellation. Neurosurgery 23:196–202CrossRefPubMed

18.

Hankinson TC, Mocco J, Kimball B, Anderson RC, Feldstein NA (2007) Internal cranial expansion procedure for the treatment of symptomatic intracranial hypertension. J Neurosurg 107:402–405. https://doi.org/10.3171/ped-07/11/402 PubMedCrossRef

19.

Higgins J, Cousins C, Owler B, Sarkies N, Pickard J (2003) Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry 74:1662–1666CrossRefPubMedPubMedCentral

20.

Hoang KB, Hooten KG, Muh CR (2017) Shunt freedom and clinical resolution of idiopathic intracranial hypertension after bariatric surgery in the pediatric population: report of 3 cases. J Neurosurg Pediatr 20:1–6. https://doi.org/10.3171/2017.6.peds17145 CrossRef

21.

The International Classification of Headache Disorders, 3rd edition (beta version) (2013). Cephalalgia : an international journal of headache 33:629–808. doi:https://doi.org/10.1177/0333102413485658

22.

Istek S (2014) Chiari type 1 malformation in a pseudotumour cerebri patient: is it an acquired or congenital Chiari malformation? BMJ case reports 2014 2014:bcr2013201845. https://doi.org/10.1136/bcr-2013-201845 CrossRef

23.

Keltner JL (1988) Optic nerve sheath decompression. How does it work? Has its time come? Archives of ophthalmology (Chicago, Ill : 1960) 106:1365–1369CrossRef

24.

Kessler LA, Novelli PM, Reigel DH (1998) Surgical treatment of benign intracranial hypertension—subtemporal decompression revisited. Surg Neurol 50:73–76CrossRefPubMed

25.

King JJ (1938) Oxycephaly: a new operation and its results (a preliminary report). Arch Neurol Psychiatr 40:1205–1219. https://doi.org/10.1001/archneurpsyc.1938.02270120155009 CrossRef

26.

Lim MJ, Pushparajah K, Jan W, Calver D, Lin JP (2010) Magnetic resonance imaging changes in idiopathic intracranial hypertension in children. J Child Neurol 25:294–299. https://doi.org/10.1177/0883073809338874 CrossRefPubMed

27.

Martins AN (1973) Resistance to drainage of cerebrospinal fluid: clinical measurement and significance. J Neurol Neurosurg Psychiatry 36:313–318CrossRefPubMedPubMedCentral

28.

Mokri B (2001) The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology 56:1746–1748CrossRefPubMed

29.

Mukherjee N, Bhatti MT (2014) Update on the surgical management of idiopathic intracranial hypertension. Current Neurology and Neuroscience Reports 14:438. https://doi.org/10.1007/s11910-014-0438-8 CrossRefPubMed

30.

Nakajima H, Sakamoto Y, Tamada I, Ohara H, Kishi K (2011) Dynamic total skull remodeling by a combination of morcellation craniotomy with distraction osteogenesis: the MoD procedure. The Journal of craniofacial surgery 22:1240–1246. https://doi.org/10.1097/SCS.0b013e31821c0fef CrossRefPubMed

31.

Orefice G, Celentano L, Scaglione M, Davoli M, Striano S (1992) Radioisotopic cisternography in benign intracranial hypertension of young obese women. A seven-case study and pathogenetic suggestions. Acta neurologica 14:39–50PubMed

32.

Paruchuri SR, Lawlor M, Kleinhomer K, Mason L, Johnson C (1993) Risk of cerebellar tonsillar herniation after diagnostic lumbar puncture in pseudotumor cerebri. Anesth Analg 77:403–404CrossRefPubMed

33.

Puffer RC, Mustafa W, Lanzino G (2013) Venous sinus stenting for idiopathic intracranial hypertension: a review of the literature. Journal of neurointerventional surgery 5:483–486. https://doi.org/10.1136/neurintsurg-2012-010468 CrossRefPubMed

34.

Quincke H (1896) Ueber Meningitis serosa und verwandte Zustände. J Neurol 9:149–168CrossRef

35.

Raichle ME, Grubb RL Jr, Phelps ME, Gado MH, Caronna JJ (1978) Cerebral hemodynamics and metabolism in pseudotumor cerebri. Ann Neurol 4:104–111. https://doi.org/10.1002/ana.410040203 CrossRefPubMed

36.

Renier D, Lajeunie E, Arnaud E, Marchac D (2000) Management of craniosynostoses. Child’s nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 16:645–658. https://doi.org/10.1007/s003810000320 CrossRef

37.

Rubin RC, Henderson ES, Ommaya AK, Walker MD, Rall DP (1966) The production of cerebrospinal fluid in man and its modification by acetazolamide. J Neurosurg 25:430–436. https://doi.org/10.3171/jns.1966.25.4.0430 CrossRefPubMed

38.

Simpson A, Wong AL, Bezuhly M (2017) Surgical correction of nonsyndromic sagittal craniosynostosis: concepts and controversies. Ann Plast Surg 78:103–110. https://doi.org/10.1097/sap.0000000000000713 CrossRefPubMed

39.

Spitze A, Malik A, Lee AG (2014) Surgical and endovascular interventions in idiopathic intracranial hypertension. Curr Opin Neurol 27:69–74. https://doi.org/10.1097/wco.0000000000000049 CrossRefPubMed

40.

Swanson JW, Aleman TS, Xu W, Ying GS, Pan W, Liu GT, Lang SS, Heuer GG, Storm PB, Bartlett SP, Katowitz WR, Taylor JA (2017) Evaluation of optical coherence tomography to detect elevated intracranial pressure in children. JAMA ophthalmology 135:320–328. https://doi.org/10.1001/jamaophthalmol.2017.0025 CrossRefPubMedPubMedCentral

41.

Tamburrini G, Caldarelli M, Massimi L, Santini P, Di Rocco C (2005) Intracranial pressure monitoring in children with single suture and complex craniosynostosis: a review. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 21:913–921. https://doi.org/10.1007/s00381-004-1117-x CrossRef

42.

Tarrats L, Hernandez G, Busquets JM, Portela JC, Serrano LA, Gonzalez-Sepulveda L, Sanchez-Perez JR (2017) Outcomes of endoscopic optic nerve decompression in patients with idiopathic intracranial hypertension. International forum of allergy & rhinology 7:615–623. https://doi.org/10.1002/alr.21927 CrossRef

43.

Thambisetty M, Lavin PJ, Newman NJ, Biousse V (2007) Fulminant idiopathic intracranial hypertension. Neurology 68:229–232. https://doi.org/10.1212/01.wnl.0000251312.19452.ec CrossRefPubMed

44.

Wall M (1990) The headache profile of idiopathic intracranial hypertension. Cephalalgia : an international journal of headache 10:331–335. https://doi.org/10.1046/j.1468-2982.1990.1006331.x CrossRef

45.

Wall M (2010) Idiopathic intracranial hypertension. Neurol Clin 28:593–617. https://doi.org/10.1016/j.ncl.2010.03.003 CrossRefPubMedPubMedCentral

46.

Wall M, George D (1991) Idiopathic intracranial hypertension: a prospective study of 50 patients. Brain 114(Pt 1A):155–180PubMed

47.

Wang SJ, Silberstein SD, Patterson S, Young WB (1998) Idiopathic intracranial hypertension without papilledema: a case-control study in a headache center. Neurology 51:245–249CrossRefPubMed

48.

Wang VY, Barbaro NM, Lawton MT, Pitts L, Kunwar S, Parsa AT, Gupta N, McDermott MW (2007) Complications of lumboperitoneal shunts. Neurosurgery 60:1045–1048; discussion 1049. https://doi.org/10.1227/01.neu.0000255469.68129.81 CrossRefPubMed

49.

Weinzweig J, Bartlett SP, Chen JC, Losee J, Sutton L, Duhaime AC, Whitaker LA (2008) Cranial vault expansion in the management of postshunt craniosynostosis and slit ventricle syndrome. Plast Reconstr Surg 122:1171–1180. https://doi.org/10.1097/PRS.0b013e3181858c84 CrossRefPubMed

50.

Winner P, Bello L (1996) Idiopathic intracranial hypertension in a young child without visual symptoms or signs. Headache 36:574–576CrossRefPubMed

Title: Cranial morcellation decompression for refractory idiopathic intracranial hypertension in children
Authors: Matheus Fernando Manzolli Ballestero
Thiago Lyrio Teixeira
Lucas Pires Augusto
Stephanie Naomi Funo de Souza
Marcelo Volpon Santos
Ricardo Santos de Oliveira
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 6/2018
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-018-3766-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cranial morcellation decompression for refractory idiopathic intracranial hypertension in children

Abstract

Background

Materials and methods

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and methods

Conclusions

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