Elevated Intracranial Pressure in Patients with Craniosynostosis by Optical Coherence Tomography

Kalmar, Christopher L.; Humphries, Laura S.; McGeehan, Brendan; Ying, Gui-shuang; Heuer, Gregory G.; Liu, Grant T.; Avery, Robert A.; Bartlett, Scott P.; Taylor, Jesse A.; Lang, Shih-Shan; Swanson, Jordan W.

doi:10.1097/prs.0000000000008821

Cited by 14 publications

(45 citation statements)

References 41 publications

(90 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using retinal OCT thresholds associated with elevated ICP, 33 subjects were assigned to a cohort of "elevated" or "normal" ICP, which was analyzed relative to the severity of metopic dysmorphology and clinical characteristics. Groups were compared using independent samples t tests for continuous data after confirming normal distributions.…”

Section: Discussionmentioning

confidence: 99%

“…All patients underwent a prospective assessment of quantitative retinal parameters, including maximum retinal nerve fiber layer thickness (MaxRNFL) and maximum anterior projection (MaxAP), using spectral-domain OCT 20. Signs suggestive of elevated ICP included MaxRNFL over 159.8 µm and MaxAP over 129.1 µm, which have been validated to correspond to an ICP of >15 mm Hg 33…”

Section: Methodsmentioning

confidence: 99%

“…31,32 All patients underwent a prospective assessment of quantitative retinal parameters, including maximum retinal nerve fiber layer thickness (MaxRNFL) and maximum anterior projection (MaxAP), using spectral-domain OCT. 20 Signs suggestive of elevated ICP included MaxRNFL over 159.8 µm and MaxAP over 129.1 µm, which have been validated to correspond to an ICP of > 15 mm Hg. 33 Our second metric for elevated ICP was direct measurement, which was performed by neurosurgery on a subset of patients as part of their clinical treatment. Direct ICP measurement was executed using a flexible Camino ICP fiberoptic probe (Integra LifeSciences) that was advanced 1 to 2 cm into the subdural space until an acceptable waveform was seen.…”

Section: Intracranial Pressure Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Relating Metopic Craniosynostosis Severity to Intracranial Pressure

Blum

Beiriger

Kalmar

et al. 2022

Journal of Craniofacial Surgery

Self Cite

View full text Add to dashboard Cite

Purpose: A subset of patients with metopic craniosynostosis are noted to have elevated intracranial pressure (ICP). However, it is not known if the propensity for elevated ICP is influenced by the severity of metopic cranial dysmorphology. Methods: Children with nonsyndromic single-suture metopic synostosis were prospectively enrolled and underwent optical coherence tomography to measure optic nerve head morphology. Preoperative head computed tomography scans were assessed for endocranial bifrontal angle as well as scaled metopic synostosis severity score (MSS) and cranial morphology deviation score determined by CranioRate, an automated severity classifier. Results: Forty-seven subjects were enrolled between 2014 and 2019, at an average age of 8.5 months at preoperative computed tomography and 11.8 months at index procedure. Fourteen patients (29.7%) had elevated optical coherence tomography parameters suggestive of elevated ICP at the time of surgery. Ten patients (21.3%) had been diagnosed with developmental delay, eight of whom demonstrated elevated ICP. There were no significant associations between measures of metopic severity and ICP. Metopic synostosis severity score and endocranial bifrontal angle were inversely correlated, as expected (r=−0.545, P<0.001). A negative correlation was noted between MSS and formally diagnosed developmental delay (r=−0.387, P=0.008). Likewise, negative correlations between age at procedure and both MSS and cranial morphology deviation was observed (r=−0.573, P<0.001 and r=−0.312, P=0.025, respectively). Conclusions: Increased metopic severity was not associated with elevated ICP at the time of surgery. Patients who underwent later surgical correction showed milder phenotypic dysmorphology with an increased incidence of developmental delay.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Intracranial Pressure Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

Relating Metopic Craniosynostosis Severity to Intracranial Pressure

Blum

Beiriger

Kalmar

et al. 2022

Journal of Craniofacial Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Also, one could hypothesize that, after exluding pseudopapilledema, an increase within the reference values during follow-up can be a sign of ICH. Swanson et al and Kalmer et al [8,32] suggest that borderline ICP can also lead to abnormalities of the retina. However, longitudinal studies should determine the outcome of patients with abnormal OCT parameters, the time after which retinal changes normalize, and the meaning of an increase of TRT within the reference values.…”

Section: Discussionmentioning

confidence: 99%

The use of OCT to detect signs of intracranial hypertension in patients with sagittal suture synostosis: Reference values and correlations

et al. 2022

View full text Add to dashboard Cite

Purpose To obtain pediatric normative reference values and determine whether optical coherence tomography (OCT) corresponds better with clinical signs of intracranial hypertension (ICH) compared to the traditional screening method fundoscopy in a large cohort of one type of single suture craniosynostosis. Methods Control subjects without optic nerve diseases and isolated sagittal synostosis patients aged 3–10 years who underwent fundoscopy and OCT were included in this prospective cohort study. Normative reference values were obtained through bootstrap analysis. Main outcome was the association between peripapillary total retinal thickness (TRT) and total retinal volume (TRV) and appearance on fundoscopy. Signs and symptoms suggestive of ICH, including skull growth arrest, fingerprinting, and headache, were scored. Results Sixty-four healthy controls and 93 isolated sagittal synostosis patients were included. Normative cut-off values for mean TRT are < 256 μm and > 504 μm and for mean TRV < 0.21 mm3 and > 0.39 mm3. TRT was increased in 16 (17%) and TRV in 15 (16%) of 93 patients, compared to only 4 patients with papilledema on fundoscopy (4%). Both parameters were associated with papilledema on fundoscopy (OR = 16.7, p = 0.02, and OR = 18.2, p = 0.01). Skull growth arrest was significantly associated with abnormal OCT parameters (OR = 13.65, p < 0.01). Conclusions The established cut-off points can be applied to screen for ICH in pediatrics. The present study detected abnormalities with OCT more frequent than with fundoscopy, which were associated with skull growth arrest. Therefore, a combination of OCT, fundoscopy, and skull growth arrest can improve clinical decision-making in craniosynostosis.

show abstract

“…In this current issue of Plastic and Reconstructive Surgery , Kalmar et al explore the relationship between occipital coherence tomography and direct intracranial pressure measurements to assess the reliability of this noninvasive test. 1 Occipital coherence tomography was commercially introduced almost 20 years ago for diagnosing optic neuropathies. 2 This test necessitates pupillary dilation and keeping the head motionless for approximately 5 to 10 minutes while scanning the retina with a low-coherence light, which is functioning like an “optical ultrasound.” 3 The authors transiently measured intracranial pressure in 42 anesthetized children using a subdural catheter, and occipital coherence tomography was also performed under the same anesthetic to accommodate younger children.…”

mentioning

confidence: 99%

Discussion: Elevated Intracranial Pressure in Patients with Craniosynostosis by Optical Coherence Tomography

Fearon¹

2022

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

Elevated Intracranial Pressure in Patients with Craniosynostosis by Optical Coherence Tomography

Cited by 14 publications

References 41 publications

Relating Metopic Craniosynostosis Severity to Intracranial Pressure

Relating Metopic Craniosynostosis Severity to Intracranial Pressure

The use of OCT to detect signs of intracranial hypertension in patients with sagittal suture synostosis: Reference values and correlations

Discussion: Elevated Intracranial Pressure in Patients with Craniosynostosis by Optical Coherence Tomography

Contact Info

Product

Resources

About