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

Authors

  • Luciano Brandão Machado Hospital de Reabilitação de Anomalias Craniofaciais (HRAC-USP), Universidade de São Paulo, São Paulo, Bauru, Brasil; Smile Train, São Paulo, Brasil. https://orcid.org/0000-0001-6806-4332
  • Michele Madeira Brandao Hospital de Reabilitação de Anomalias Craniofaciais (HRAC-USP), Universidade de São Paulo, São Paulo, Bauru, Brasil https://orcid.org/0000-0001-5919-0759
  • Andre Ferro Hospital de Reabilitação de Anomalias Craniofaciais (HRAC-USP), Universidade de São Paulo, São Paulo, Bauru, Brasil; https://orcid.org/0000-0002-6817-722X
  • Tales Shinji Sawakuchi Minei Hospital de Reabilitação de Anomalias Craniofaciais (HRAC-USP), Universidade de São Paulo, São Paulo, Bauru, Brasil; https://orcid.org/0000-0003-4380-428X
  • Igor José Nogueira Gualberto Hospital de Reabilitação de Anomalias Craniofaciais (HRAC-USP), Universidade de São Paulo, São Paulo, Bauru, Brasil; https://orcid.org/0000-0001-7333-1722
  • Nivaldo Alonso Hospital de Reabilitação de Anomalias Craniofaciais (HRAC-USP), Universidade de São Paulo, São Paulo, Bauru, Brasil; Disciplina de Cirurgia Plástica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil; Smile Train, São Paulo, Brasil. https://orcid.org/0000-0003-1532-9610

DOI:

https://doi.org/10.46900/apn.v5i3.190

Keywords:

Acrocephalosyndactyly (Apert), Anesthesia, Intracranial pressure

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.

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Published

2024-01-08

How to Cite

1.
Brandão Machado L, Brandao MM, Ferro A, Minei TSS, Gualberto IJN, Alonso N. Anesthesia for preoperative non-invasive intracranial pressure measurement in a child with Apert syndrome: a case report. Arch Pediatr Neurosurg [Internet]. 2024 Jan. 8 [cited 2024 Jun. 17];6(1):e1902023. Available from: https://archpedneurosurg.com.br/sbnped2019/article/view/190