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Pediatric Surgeons’ Novel Approach to Relieving Pressure on the Brain

What appears to be a radical surgery to relieve brain pressure may prove to be the most effective and logical for patients with resistant high pressure conditions like Idiopathic Intracranial Hypertension (IIH). Drs. Saadi Ghatan and Neil Feldstein from the Pediatric Neurosurgery Center explained a procedure called Internal Cranial Expansion (ICE) and its effectiveness to their colleagues at this year’s meeting of The American Society of Pediatric Neurosurgeons.

IIH, also called Pseudotumor Cerebri, 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. Also, the increased pressure can damage nerves, particularly those that effect vision in 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.  Ghatan and Feldstein explained to their colleagues how ICE is performed and how a select group of IIH patients responded.

ICE involves four large craniotomies, or 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.

Ghatan and Feldstein have had tremendous results, particularly with patients who have had multiple shunting surgeries and those with rapidly progressing visual problems.

In the group of children with IIH who had this procedure, they saw, “Resolution of papilledema within 4 weeks, normalization of Intracranial Pressure (ICP) in all patients, resolution of headaches in four out of five patients, and successful removal of shunts in all patients.”

Based on their experience with this population, Ghatan and Feldstein concluded that, “Internal Cranial Expansion provides lasting normalization of ICP, visual symptoms and papilledema were well treated, but headaches often require multidisciplinary management in the long run.”

To learn more about this procedure see the article, Internal Cranial Expansion Procedure for the Treatment of Symptomatic Intracranial hypertension: Technical note in the Journal of Neurosurgery: Pediatrics.

patient journey

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