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Pediatric Neurosurgeons’ Novel Procedure to Relieve Brain Pressure Published in Journal of Neurosurgery: Pediatrics

Internal Cranial Expansion (ICE for short)

Surgeons from our Pediatric Neurosurgery Center have developed a novel procedure to help children with hard-to-treat cases of increased brain pressure.

Co-Authors Dr. Richard Anderson and Dr. Neil Feldstein describe the procedure in the July 2012 issue of the Journal of Neurosurgery:Pediatrics in an article entitled, internal cranial expansion surgery for the treatment of refractory idiopathic intracranial hypertension.

Idiopathic Intracranial Hypertension (IIH) is a condition where pressure inside the skull is chronically too high and no specific cause can be found. It is most common in obese females and the symptoms include headaches, nausea, and vomiting. The increased pressure can damage nerves, particularly those that effect vision creating a condition called papilledema.

IIH is treated in a number of ways primarily using shunts. These are one way valves that drain fluid off the brain to help reduce the pressure. In some cases the shunts fail or aren’t enough to relieve the pressure and surgeons need to consider other options.

Dr. Anderson and Dr. Feldstein have developed a procedure, called Internal Cranial Expansion (ICE for short), that has been particularly effective in treating those with a diagnosis of IIH.

ICE involves four large craniotomies (removal of bone flaps). The calvaria, or underside of the skull bone, is removed or thinned from the bone flaps and along the borders of the craniotomies. This gives the brain more room and logically, with more room, there is less pressure inside the skull.  Furthermore, with this procedure, surgeons do not have to operate inside the delicate structure of the brain.

The authors reviewed ten cases of ICE that they performed over the last five years and concluded, “Internal cranial expansion is a safe and effective surgery for the treatment of patients with refractory IIH. This surgery expands the intracranial volume and thus promotes ICP normalization, which may lead to the reduction or complete resolution of the signs and symptoms of IIH. Internal cranial expansion may be used as part of a multidisciplinary management approach in the treatment of refractory IIH.”

Learn more about this procedure in the article, internal cranial expansion surgery for the treatment of refractory idiopathic intracranial hypertension in the  Journal of Neurosurgery:Pediatrics, July 2012, Volume 10, Number 1 or read the abstract on pubmed here.

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