Pressure sensing device for intracranial implantation following cranial vault remodeling for long-term intracranial pressure monitoring in craniosynostosis

Project Overview

Craniosynostosis refers to the premature fusion of one or more cranial sutures, which can result in a specific pattern of skull deformities due to restriction of growth at the fused suture. The incidence is estimated to be 1 in 2500 live births and can involve fusion of an isolated cranial suture or present as part of a craniosynostosis syndrome involving multiple sutures and other congenital anomalies. The growth restriction from the premature suture fusion can result in cephalocranial disproportion with elevated intracranial pressure (ICP) and negative effects on the rapidly developing brain causing headaches, developmental delays, and other neurologic sequelae. The treatment of craniosynostosis is surgical with bony remodeling and expansion of the skull in infancy by a multidisciplinary team of craniofacial plastic surgeons and neurosurgeons to normalize head shape and create more space for the growing brain. The specific surgical procedure selected is based on the sutures involved as well as the severity of the deformity and can include spring mediated cranioplasty, posterior cranial vault expansion, bifronto-orbital advancement, as well as a variety of distraction osteogenesis procedures.

Following surgical treatment, patients are followed closely to monitor for signs of elevated ICPs and associated adverse neurodevelopmental consequences as this would require repeat cranial vault expansion. However, there is no reliable noninvasive method to measure ICP. Plastic surgeons look for headaches, head banging, and developmental delays as potential signs of elevated ICPs. Patients also undergo regular dilated fundoscopic exams by ophthalmologists to look for papilledema, which can be associated with intracranial hypertension. Other more quantitative methods such as optical coherence tomography, serial visual evoked potentials, and near-infrared spectroscopy have been used by some craniofacial centers with varying levels of diagnostic accuracy but require expensive equipment, patient compliance or sedation, and trained personnel. Unfortunately, none of these non-invasive techniques has sufficient specificity or sensitivity to dependably detect elevated ICPs, which is essential to identify children that need repeat surgical intervention to maximize their developmental outcomes. The gold standard for ICP measurement is surgical and requires temporary placement of a intracranial pressure monitor under the dura through a burr hole in the skull under general anesthesia, which is invasive and associated with many potential complications.

The goal of this project is to develop a pressure sensing device to be placed on the endocranial surface of the bone at the time of cranial vault remodeling in patients with craniosynostosis. The device must be sensitive enough to identify when the ICP exceeds a threshold of 15 and 20 mm of Hg then provide this information in a non-invasive manner (e.g. with a radio-opaque gauge that can be read on skull x-rays). The implantable pressure sensor must remain functional for 10-15 years to allow for longitudinal ICP monitoring throughout childhood but remain biocompatible and not cause any negative effects on the underlying brain or dura throughout the lifetime of the patient as this device will not likely be removed. While the focus of this project is on the longitudinal monitoring of ICPs for craniosynostosis, there are many potential neurosurgical applications for this technology if the device can be designed to be deployed in a minimally invasive fashion.

Team Picture

Contact Information

Team Members

• Karina Buttram - Team Leader
• Vivian Woo - Communicator
• Joseph Ho - BSAC
• Caroline Craig - BWIG
• Adrienne Simpson - BPAG
• Matthew Stenerson

Advisor and Client

• Prof. John Puccinelli - Advisor
• Dr. Daniel Cho - Client

Related Projects

• Fall 2023: Implantable pressure sensing device for longitudinal intracranial pressure monitoring in craniosynostosis
• Spring 2023: Implantable pressure sensing device for longitudinal intracranial pressure monitoring in craniosynostosis
• Fall 2022: Implantable pressure sensing device for longitudinal intracranial pressure monitoring in craniosynostosis