Postoperative raised ICP after minimally invasive surgery for monosutural craniosynostosis

INTRODUCTION: Minimally invasive craniectomies (MIC) for monosutural craniosynostosis are more and more used. Their results are usually investigated in terms of surgical, esthetic, and neuropsychological outcomes but not specifically about the risk of postoperative raised intracranial pressure (ICP). The goal of this article is to review the literature and the personal experience looking for the possible risk of postoperative raised ICP after MIC. METHODS: A systematic review adhering to PRISMA guidelines was realized. In parallel, the personal experience concerning scaphocephalic children consecutively operated on between 2010 and 2013 by MIC was analyzed. Children operated on by open cranial vault remodeling (OCVR) in the same period were considered as controls. RESULTS: Overall, 3048 patients from 14 studies were included, 5% of them requiring a reoperation after a 59.9-month mean follow-up. A total of 2297 children were treated by MIC: 2.8% (65 cases) showed postoperative raised ICP, the rate of reoperation was 4.4% (102 cases). The risk of reoperation varies across the techniques, being higher in modified or spring-assisted strip craniectomies (2.4-14.6%) than in endoscopy-assisted craniectomies (2.4%). Among 751 cases treated by OCVR, this risk varied from 0.95 to 7.1%. Also in the personal experience, no significant differences were found between MIC (1.5% of reoperation for raised ICP) and OCVR (0.8%). CONCLUSIONS: The risk of postoperative raised ICP seems to be relatively low after surgery for monosutural synostosis without a significant difference between MIC and OCVR. Missing standardized methods for postoperative screening, missing information about the reason of reoperation in some studies, and the retrospective analysis methods in most of them are the main limitations of this study.