What volume increase is needed for the management of raised intracranial pressure in children with craniosynostosis

Craniosynostosis describes a fusion of one or more sutures in the skull. It can occur in isolation or as part of a syndrome. In either setting, it is a condition which may lead to raised intracranial pressure. The exact cause of raised intracranial pressure in craniosynostosis is unknown. It may be due to; a volume mismatch between the intracranial contents and their containing cavity, venous hypertension, hydrocephalus or airway obstruction, which is often a sequela of an associated syndrome. At Great Ormond Street Hospital, after hydrocephalus and airway obstruction have been treated, the next surgical treatment of choice is cranial vault expansion. This expansion has been shown to reduce intracranial pressure, interestingly despite its success, the reasons behind its benefits are not fully understood. Using reconstructed 3-dimensional imaging, accurate measurement of cranial volumes can now be achieved. The aim of this project is to use the advances in 3-dimensional imaging and image processing to provide novel information on the volume changes that occur following cranial vault expansion. This information will be combined with clinical metrics to create a greater understanding of the causes of raised intracranial pressure in craniosynostosis, why cranial vault expansion treats them and whether there is an optimal volume expansion.