Anesthesia for preoperative non-invasive intracranial pressure measurement in a child with Apert syndrome: a case report

Abstract

Introduction: The presence of craniofacial alterations such as craniosynostosis and midface hypoplasia are some features of Apert syndrome. Those characteristics may lead to intracranial hypertension. For clinical evaluation, a non-invasive intracranial pressure measurement can be performed both as a preoperative examination and to evaluate surgical treatment. Several methods have been used to measure intracranial pressure non-invasively, such as optic nerve sheath ultrasound, optical coherence tomography, and intracranial pressure waveform (ICPw) monitoring with the sensor Brain4Care®. Some methods like ICPw, require that the patient remains standstill. Because the patient wasn’t cooperative, it was decided to register the ICPw under hypnosis. A specific anesthetic planning was done to minimize the impact on the ICPw.

Case presentation: We present a 6 years old child with Apert Syndrome with ICPw registered by Brain4Care® device before and after monobloc craniofacial advancement with internal distraction. The chosen anesthetic was Sevoflurane at a dose ≤ 0.9% of inspired gases and air/oxygen proportion of 50/50%, with a laryngeal mask, under spontaneous ventilation, with normal end-tidal CO2 range. The preoperative ICPw suggested low cranial compliance, with a mean P2/P1 index above 1,2. The postoperative showed a mean P2/P1 index under 1.2, demonstrating improved cranial compliance. The same anesthetic planning was done on both occasions.

Conclusion: Likely, an appropriate way to obtain a reliable non-invasive ICPw measurement under hypnosis includes positioning the patient at neutral decubitus, choosing hypnotics with minimal impact on ICP, and maintaining spontaneous ventilation during the exam.