The jugular foramen in complex and syndromic craniosynostosis and its relationship to raised intracranial pressure.

BACKGROUND AND PURPOSE Complex and syndromic craniosynostosis can be complicated by raised intracranial pressure (ICP), which in the absence of other identifiable origins, is probably caused by venous hypertension. Children with these conditions have been shown to have narrowing of the sigmoid sinus-jugular vein complex. Evidence of bony narrowing of the jugular foramina in children with complex or syndromic craniosynostosis and raised ICP compared with that in children with craniosynostosis without raised ICP would provide support for the theory that venous hypertension occurs in the former children. METHODS Measurements of the jugular foramina were obtained from reformatted helical CT scans obtained in 12 children with complex or syndromic craniosynostosis and raised ICP (group 1) and in two control groups of children with normal ICP. The first control group comprised 10 children with simple nonsyndromic synostosis of one or two sutures (group 2), and the second control group included nine children with complex or syndromic craniosynostosis (group 3). RESULTS Children with raised ICP had narrower jugular foramina than did the age-matched control subjects. For group 1, the mean diameter of jugular foramina was 6.5 mm; group 2, 11.5 mm (P <.01); and group 3, 10 mm (P <.05). No significant difference existed between the two control groups. CONCLUSION Significantly narrower jugular foramina in children with raised ICP is further evidence of the role of venous outflow obstruction and intracranial venous hypertension in the development of raised ICP in complex and syndromic craniosynostosis.