Mild trigonocephaly and intracranial pressure: report of 56 patients

Introduction: We report the surgical results in patients with mild trigonocephaly and clinical symptoms. Since high intracranial pressure (ICP) was noted during surgery in our previous patient series, we began to record intraoperative ICP. The importance of treating mild trigonocephaly with clinical symptoms is stressed.

Patients and methods: Fifty-six children (44 boys, 12 girls) in whom ICP was measured were diagnosed with mild trigonocephaly (nonsyndromic type) with symptoms such as language delay, hyperactivity, autistic tendencies, self-mutilation, motor delay, etc. Their ages ranged from 2 to 8 (mean 5.1) years. ICP was measured after a burr hole was made under endotracheal general anesthesia and a sensor was inserted in the right frontal lobe epidurally immediately in front of the right coronal suture. The first recordings were made at around 30 mmHg of PCO(2) as for neuroanesthesia, and the second were at around 40 mmHg of PCO(2) as during natural breathing. We also investigated which factors accounted for the improvement of clinical symptoms.

Results: The first ICP records at 29.1 mmHg of PCO(2) indicated a mean ICP of 13.3 mmHg. The second changed to a mean 38.2 mmHg of PCO(2) for an increased mean ICP of 19.8 mmHg. The pulse pressures were a mean 7.1 mmHg in the first recordings and 8.5 mmHg in the second. The mean ICP and pulse pressure were thus high in these children. Clinically, 30 out of 56 patients improved markedly and 22 improved slightly, while 4 did not exhibit any change. Factors contributing to improvement were younger age, relatively higher development quotient, marked digital impressions on skull X-rays, abnormal findings on SPECT, and moderate degree of trigonocephaly.

Conclusion: Although our patients had mild trigonocephaly, their ICP and pulse pressure were high. Decompressive cranioplasty in cases of mild trigonocephaly is feasible.