Department of Neurological Surgery, Regional University Hospital, Malaga, Spain.
Pediatric Neurological Surgery Section, Department of Neurological Surgery, Regional University Hospital, Malaga, Spain.
Neurosurg Rev. 2022 Feb;45(1):897-901. doi: 10.1007/s10143-021-01571-9. Epub 2021 Jun 1.
Intracranial hypertension may be idiopathic or due to multiple etiologies. Some bone dysplasias and chronic shunt overdrainage syndrome may sometimes lead to intracranial hypertension associated with craniocerebral disproportion due to thickening of cranial diploe. The internal cranial expansion procedure has been used for patients with intracranial hypertension, whether or not associated with craniocerebral disproportion. Its purpose is to increase the intracranial volume by drilling down the inner table. This technique enables the craniocerebral disproportion to be improved and intracranial hypertension reduced. In other etiologies of intracranial hypertension with non-thickened diploe, internal cranial expansion may not be enough to resolve the hypertension. For these cases we propose a modification of the technique by expanding the cranial vault outwards; external cranial expansion. We describe this technique as used in a pediatric patient who presented with chronic headache, tonsillar ectopia, and sleep apnea syndrome. This patient also had a multisuture craniosynostosis, a non-thickened diploe, and intracranial hypertension.
颅内高压可能是特发性的，也可能由多种病因引起。一些骨发育不良和慢性分流过度引流综合征有时可能导致颅内高压，伴有由于颅板增厚引起的颅腔与脑不成比例。颅内扩张术已用于治疗颅内高压患者，无论是否伴有颅腔与脑不成比例。其目的是通过钻通内板来增加颅内容积。该技术可改善颅腔与脑不成比例的情况，并降低颅内压。在颅板不增厚的其他颅内高压病因中，颅内扩张术可能不足以解决高血压问题。对于这些病例，我们提出了一种通过向外扩张颅盖来修改该技术的方法，即外部颅扩张。我们描述了该技术在一名患有慢性头痛、扁桃体下疝和睡眠呼吸暂停综合征的儿科患者中的应用。该患者还患有多缝颅缝早闭、颅板不增厚和颅内高压。
