{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T04:13:20Z","timestamp":1793333600665,"version":"4.5.0"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,1]]},"abstract":"<jats:p content-type=\"fine-print\">\n                    <jats:italic>Object.<\/jats:italic>\n                    Elevated intracranial pressure (ICP) is a well-recognized complication affecting children suffering from complex forms of craniosynostosis. The effects of ICP, including those on vision, and the underlying mechanisms involved remain uncertain. The aim of this study was to examine the relationships among ICP, cerebral perfusion pressure (CPP), and the episodic alterations in respiratory obstruction that are common in children with craniosynostosis.\n                  <\/jats:p>\n                  <jats:p content-type=\"fine-print\">\n                    <jats:italic>Methods.<\/jats:italic>\n                    Eleven children with complex craniosynostosis underwent monitoring overnight, including simultaneous recording of subdural ICP, arterial blood pressure (ABP), and a variety of respiratory parameters. Sleep status was also analyzed. Mean values were calculated for all variables, including ICP, CPP, and ABP, during both quiet and active sleep.\n                  <\/jats:p>\n                  <jats:p content-type=\"fine-print\">Mean ICP during quiet sleep was elevated in five patients, borderline in three, and normal in three children. During active sleep, plateaus of high mean ICP were observed in all patients. Marked decreases in CPP were demonstrated during active sleep with absolute values as low as 14 mm Hg. During quiet sleep, the mean baseline CPP was 53.3 mm Hg (range 34\u201370 mm Hg). During active sleep, CPP fell to a mean of 32.6 mm Hg (range 23\u201352 mm Hg). All patients experienced obstructive breathing problems, including 10 with obstructive sleep apnea, the effects of which demonstrated a temporal relationship to the alterations in sleep status, ICP, and CPP. Elevations of ABP appeared modest and remained within the normal limits for age.<\/jats:p>\n                  <jats:p content-type=\"fine-print\">\n                    <jats:italic>Conclusions.<\/jats:italic>\n                    The findings of this study indicate that ICP, CPP, and respiratory obstruction interact in a vicious cycle, an observation that helps explain the pattern of plateau waves of elevated ICP characteristic among children with complex forms of craniosynostosis. The data gathered in this series revealed levels of CPP considerably lower than those described previously in clinical reports. Such reductions in CPP most likely contribute to the neurological, cognitive, and ophthalmological morbidity from which these children suffer frequently; therefore, the results of this study have important implications for the management of children with complex forms of craniosynostosis as well as for our understanding of the control of cerebral blood flow in general.\n                  <\/jats:p>","DOI":"10.3171\/ped.2005.102.1.0016","type":"journal-article","created":{"date-parts":[[2010,8,27]],"date-time":"2010-08-27T06:01:06Z","timestamp":1282888866000},"page":"16-22","source":"Crossref","is-referenced-by-count":27,"title":["How low can you go? Intracranial pressure, cerebral perfusion pressure, and respiratory obstruction in children with complex craniosynostosis"],"prefix":"10.3171","volume":"102","author":[{"given":"Richard","family":"Hayward","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Gonsalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Eur Respir J","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1183\/09031936.94.07040786","article-title":"The cardiovascular effects of obstructive sleep apnoeas: analysis of pathogenic mechanisms.","volume":"7","author":"Bonsignore","year":"1994"},{"key":"b2","series-title":"Neurosurgery\u2014the Scientific Basis of Clinical Practice","first-page":"127","article-title":"Cerebral blood flow","volume":"1","author":"Bowler","year":"2000"},{"key":"b3","series-title":"Brain Insults in Infants and Children. Pathophysiology and Management.","first-page":"52","article-title":"Cerebrovascular dynamics","author":"Bruce","year":"1985"},{"key":"b4","series-title":"Principles and Practice of Sleep Medicine in the Child.","first-page":"163","article-title":"Obstructive sleep apnea syndrome in infants and children: clinical features and pathophysiology","author":"Carroll","year":"1995"},{"key":"b5","series-title":"Eur Respir J","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1183\/09031936.97.10020367","article-title":"Upper airway obstruction and elevated intracranial pressure in children with craniosynostosis.","volume":"10","author":"Gonsalez","year":"1997"},{"key":"b6","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1097\/00006534-199602000-00004","article-title":"Morbidity associated with increased intracranial pressure in Apert and Pfeiffer syndromes: the need for long-term evaluation.","volume":"97","author":"Gosain","year":"1996"},{"key":"b7","series-title":"Ophthalmologica","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1159\/000309386","article-title":"The sheath of the optic nerve.","volume":"189","author":"Hayreh","year":"1984"},{"key":"b8","series-title":"Brit J Ophthalmol","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1136\/bjo.87.8.999","article-title":"Visual outcomes and amblyogenic risk factors in craniosynostotic syndromes: a review of 141 cases.","volume":"87","author":"Khan","year":"2003"},{"key":"b9","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1097\/00006534-199508000-00005","article-title":"Twenty-year experience with early surgery for craniosynostosis: II. The craniofacial synostosis syndromes and pansynostosis\u2014results and unsolved problems.","volume":"96","author":"McCarthy","year":"1995"},{"issue":"113\u2013114","key":"b10","series-title":"Clinics in Developmental Medicine","article-title":"Problems of intracranial pressure in childhood","year":"1991"},{"key":"b11","series-title":"Cleft Palate Craniofac J","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1597\/1545-1569_1998_035_0190_citdam_2.3.co_2","article-title":"Controversies in the diagnosis and management of craniosynostosis: a panel discussion.","volume":"35","author":"Mouradian","year":"1998"},{"key":"b12","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/S1042-3680(18)30721-6","article-title":"Ophthalmic features of craniosynostosis.","volume":"2","author":"Newman","year":"1991"},{"key":"b13","series-title":"Brain Res","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/0006-8993(74)90454-5","article-title":"The behavioural states of the newborn infant (a review).","volume":"76","author":"Prechtl","year":"1974"},{"key":"b14","series-title":"Arch Ophthalmol","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.1001\/archopht.118.12.1626","article-title":"Papilledema and obstructive sleep apnea syndrome.","volume":"118","author":"Purvin","year":"2000"},{"key":"b15","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s003810000320","article-title":"Management of craniosynostoses.","volume":"16","author":"Renier","year":"2000"},{"key":"b16","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"370","DOI":"10.3171\/jns.1982.57.3.0370","article-title":"Intracranial pressure in craniostenosis.","volume":"57","author":"Renier","year":"1982"},{"key":"b17","series-title":"Drug Doses: Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria","author":"Shann","year":"2003"},{"key":"b18","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1542\/peds.41.4.829","article-title":"Craniosynostosis: a review of 519 surgical patients.","volume":"41","author":"Shillito","year":"1968"},{"key":"b19","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1227\/00006123-199504000-00010","article-title":"The detection and management of intracranial hypertension after initial suture release and decompression for craniofacial dysostosis syndromes.","volume":"36","author":"Siddiqi","year":"1995"},{"key":"b20","series-title":"Handbook of Sleep-Related Breathing Disorders","first-page":"23","article-title":"Pathophysiology of obstructive sleep apnoea","year":"1993"},{"key":"b21","series-title":"Electroencephalogr Clin Neurophysiol","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/0013-4694(85)90033-1","article-title":"Marked episodic elevation of cerebrospinal fluid pressure during nocturnal sleep in patients with sleep apnea hypersomnia syndrome.","volume":"60","author":"Sugita","year":"1985"},{"key":"b22","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"377","DOI":"10.3171\/jns.2001.94.3.0377","article-title":"Enigma of elevated intracranial pressure in patients with complex craniosynostosis: the role of abnormal intracranial venous drainage.","volume":"94","author":"Taylor","year":"2001"},{"key":"b23","series-title":"Principles and Practice of Sleep Medicine in the Child.","first-page":"55","article-title":"Monitoring of sleep in neonates and young children","author":"Thoman","year":"1995"},{"key":"b24","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/BF00301758","article-title":"Subdural intracranial pressure monitoring in craniosynostosis: its role in surgical management.","volume":"11","author":"Thompson","year":"1995"},{"key":"b25","series-title":"Arch Ophthalmol","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1001\/archopht.1977.04450080168023","article-title":"Optic disc edema in elevated intracranial pressure: IV. Axoplasmic transport in experimental papilledema.","volume":"95","author":"Tso","year":"1977"},{"key":"b26","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1097\/00006123-199602000-00009","article-title":"The effectiveness of papilledema as an indicator of elevated intracranial pressure in children with craniosynostosis.","volume":"38","author":"Tuite","year":"1996"},{"key":"b27","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/0090-3019(84)90116-2","article-title":"Intracranial pressure changes in craniostenosis.","volume":"21","author":"Whittle","year":"1984"},{"key":"b1","series-title":"Eur Respir J","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1183\/09031936.94.07040786","article-title":"The cardiovascular effects of obstructive sleep apnoeas: analysis of pathogenic mechanisms.","volume":"7","author":"Bonsignore","year":"1994"},{"key":"b2","series-title":"Neurosurgery\u2014the Scientific Basis of Clinical Practice","first-page":"127","article-title":"Cerebral blood flow","volume":"1","author":"Bowler","year":"2000"},{"key":"b3","series-title":"Brain Insults in Infants and Children. Pathophysiology and Management.","first-page":"52","article-title":"Cerebrovascular dynamics","author":"Bruce","year":"1985"},{"key":"b4","series-title":"Principles and Practice of Sleep Medicine in the Child.","first-page":"163","article-title":"Obstructive sleep apnea syndrome in infants and children: clinical features and pathophysiology","author":"Carroll","year":"1995"},{"key":"b5","series-title":"Eur Respir J","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1183\/09031936.97.10020367","article-title":"Upper airway obstruction and elevated intracranial pressure in children with craniosynostosis.","volume":"10","author":"Gonsalez","year":"1997"},{"key":"b6","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1097\/00006534-199602000-00004","article-title":"Morbidity associated with increased intracranial pressure in Apert and Pfeiffer syndromes: the need for long-term evaluation.","volume":"97","author":"Gosain","year":"1996"},{"key":"b7","series-title":"Ophthalmologica","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1159\/000309386","article-title":"The sheath of the optic nerve.","volume":"189","author":"Hayreh","year":"1984"},{"key":"b8","series-title":"Brit J Ophthalmol","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1136\/bjo.87.8.999","article-title":"Visual outcomes and amblyogenic risk factors in craniosynostotic syndromes: a review of 141 cases.","volume":"87","author":"Khan","year":"2003"},{"key":"b9","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1097\/00006534-199508000-00005","article-title":"Twenty-year experience with early surgery for craniosynostosis: II. The craniofacial synostosis syndromes and pansynostosis\u2014results and unsolved problems.","volume":"96","author":"McCarthy","year":"1995"},{"issue":"113\u2013114","key":"b10","series-title":"Clinics in Developmental Medicine","article-title":"Problems of intracranial pressure in childhood","year":"1991"},{"key":"b11","series-title":"Cleft Palate Craniofac J","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1597\/1545-1569_1998_035_0190_citdam_2.3.co_2","article-title":"Controversies in the diagnosis and management of craniosynostosis: a panel discussion.","volume":"35","author":"Mouradian","year":"1998"},{"key":"b12","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/S1042-3680(18)30721-6","article-title":"Ophthalmic features of craniosynostosis.","volume":"2","author":"Newman","year":"1991"},{"key":"b13","series-title":"Brain Res","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/0006-8993(74)90454-5","article-title":"The behavioural states of the newborn infant (a review).","volume":"76","author":"Prechtl","year":"1974"},{"key":"b14","series-title":"Arch Ophthalmol","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.1001\/archopht.118.12.1626","article-title":"Papilledema and obstructive sleep apnea syndrome.","volume":"118","author":"Purvin","year":"2000"},{"key":"b15","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s003810000320","article-title":"Management of craniosynostoses.","volume":"16","author":"Renier","year":"2000"},{"key":"b16","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"370","DOI":"10.3171\/jns.1982.57.3.0370","article-title":"Intracranial pressure in craniostenosis.","volume":"57","author":"Renier","year":"1982"},{"key":"b17","series-title":"Drug Doses: Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria","author":"Shann","year":"2003"},{"key":"b18","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1542\/peds.41.4.829","article-title":"Craniosynostosis: a review of 519 surgical patients.","volume":"41","author":"Shillito","year":"1968"},{"key":"b19","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1227\/00006123-199504000-00010","article-title":"The detection and management of intracranial hypertension after initial suture release and decompression for craniofacial dysostosis syndromes.","volume":"36","author":"Siddiqi","year":"1995"},{"key":"b20","series-title":"Handbook of Sleep-Related Breathing Disorders","first-page":"23","article-title":"Pathophysiology of obstructive sleep apnoea","year":"1993"},{"key":"b21","series-title":"Electroencephalogr Clin Neurophysiol","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/0013-4694(85)90033-1","article-title":"Marked episodic elevation of cerebrospinal fluid pressure during nocturnal sleep in patients with sleep apnea hypersomnia syndrome.","volume":"60","author":"Sugita","year":"1985"},{"key":"b22","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"377","DOI":"10.3171\/jns.2001.94.3.0377","article-title":"Enigma of elevated intracranial pressure in patients with complex craniosynostosis: the role of abnormal intracranial venous drainage.","volume":"94","author":"Taylor","year":"2001"},{"key":"b23","series-title":"Principles and Practice of Sleep Medicine in the Child.","first-page":"55","article-title":"Monitoring of sleep in neonates and young children","author":"Thoman","year":"1995"},{"key":"b24","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/BF00301758","article-title":"Subdural intracranial pressure monitoring in craniosynostosis: its role in surgical management.","volume":"11","author":"Thompson","year":"1995"},{"key":"b25","series-title":"Arch Ophthalmol","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1001\/archopht.1977.04450080168023","article-title":"Optic disc edema in elevated intracranial pressure: IV. Axoplasmic transport in experimental papilledema.","volume":"95","author":"Tso","year":"1977"},{"key":"b26","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1097\/00006123-199602000-00009","article-title":"The effectiveness of papilledema as an indicator of elevated intracranial pressure in children with craniosynostosis.","volume":"38","author":"Tuite","year":"1996"},{"key":"b27","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/0090-3019(84)90116-2","article-title":"Intracranial pressure changes in craniostenosis.","volume":"21","author":"Whittle","year":"1984"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/102\/1\/article-p16.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/102\/1\/article-p16.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/102\/1\/article-p16.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T10:18:53Z","timestamp":1782209933000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/102\/1\/article-p16.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,1]]},"references-count":54,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/ped.2005.102.1.0016","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[2005,1]]}}}