Optical Coherence Tomography Can Detect Intracranial Hypertension in Young Children with Craniosynostosis

Swanson, Jordan; Xu, Wen; Alemán, Tomás S.; Mitchell, Brianne; Wes, Ari M.; Chen, Shih-Shan; Bender, Lloyd; Heuer, Greg; Katowitz, William R.; Bartlett, Scott P.; Taylor, J. Norton

doi:10.1097/01.prs.0000472324.43630.b1

Cited by 3 publications

(3 citation statements)

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“…Therefore, there has been great historical interest in non-invasive modalities for assessing the presence or absence of IH. Options that have been utilized, with varying degrees of success and uptake, include fundoscopy [6], visual electrodiagnostic tests [7], optical coherence tomography [8], and optic nerve sheath ultrasound [9].…”

Section: Introductionmentioning

confidence: 99%

Lack of association of cranial lacunae with intracranial hypertension in children with Crouzon syndrome and Apert syndrome: a 3D morphometric quantitative analysis

et al. 2019

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Purpose Cranial lacunae (foci of attenuated calvarial bone) are CT equivalents of Bcopper beating^seen on plain skull radiographs in children with craniosynostosis. The qualitative presence of copper beating has not been found to be useful for the diagnosis of intracranial hypertension (IH) in these patients. 3D morphometric analysis (3DMA) allows a more systematic and quantitative assessment of calvarial attenuation. We used 3DMA to examine the relationship between cranial lacunae and IH in children with Crouzon and Apert syndromic craniosynostosis. Methods Patients were divided into IH and non-IH groups defined on an intention-to-treat basis. Pre-operative CT scans were converted into 3D skull models and processed to quantify lacunae as a percentage of calvarium surface area (LCP). This was done on individual bone and whole skull basis. Results Eighteen consecutive children with Crouzon's syndrome and 17 with Apert syndrome were identified. Median age at CT scan was 135 days (range 6-1778). Of the 35 children, 21 required surgery for IH at median age of 364 days (range 38-1710). Of these 21 children, 14 had lacunae with mean LCP of 3% (0-28%). Of the 14 non-IH children, 8 had lacunae with mean LCP of 2% (0-8%). LCP was not significantly different between IH and non-IH groups. Parietal bones were most likely to show lacunae (IH 14/21, non-IH 9/14), followed by occipital (IH 8/21, non-IH 3/14), and frontal (IH 6/21, non-IH 2/14). Conclusion Results suggest that cranial lacunae, measured using quantitative 3DMA, do not correlate with IH, in agreement with evidence from qualitative plain skull radiograph studies.

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Section: Introductionmentioning

confidence: 99%

Lack of association of cranial lacunae with intracranial hypertension in children with Crouzon syndrome and Apert syndrome: a 3D morphometric quantitative analysis

et al. 2019

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“…Classic symptoms of elevated ICP such as headache, behavioral changes, or vomiting are unreliable, particularly among infants and children,19,20 and intradural measurement is invasive. Alternatively, spectral-domain optical coherence tomography (OCT) of the optic nerve demonstrates features associated with elevated ICP and has shown high sensitivity and specificity among patients with craniosynostosis 19–23…”

Section: Introductionmentioning

confidence: 99%

“…Alternatively, spectral-domain optical coherence tomography (OCT) of the optic nerve demonstrates features associated with elevated ICP and has shown high sensitivity and specificity among patients with craniosynostosis. [19][20][21][22][23] Examination of the relationship between neurocognitive deficits and phenotypic severity in patients with metopic craniosynostosis has yielded mixed findings, with a lack of conclusive evidence in either direction. 5,12,[24][25][26][27] This inconsistency in findings is in part attributable to methodological variation in metopic severity and intelligence measures, precluding direct comparison of results across investigations.…”

Section: Introductionmentioning

confidence: 99%

Relating Metopic Craniosynostosis Severity to Intracranial Pressure

Blum

Beiriger

Kalmar

et al. 2022

Journal of Craniofacial Surgery

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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.

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Classification and Evaluation of Orbital Disorders in Children

Katowitz¹,

Fries²

2017

Pediatric Oculoplastic Surgery

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Optical Coherence Tomography Can Detect Intracranial Hypertension in Young Children with Craniosynostosis

Cited by 3 publications

References 0 publications

Lack of association of cranial lacunae with intracranial hypertension in children with Crouzon syndrome and Apert syndrome: a 3D morphometric quantitative analysis

Lack of association of cranial lacunae with intracranial hypertension in children with Crouzon syndrome and Apert syndrome: a 3D morphometric quantitative analysis

Relating Metopic Craniosynostosis Severity to Intracranial Pressure

Classification and Evaluation of Orbital Disorders in Children

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