Papilledema in Isolated Single-Suture Craniosynostosis

Abstract

The purpose of this retrospective study was to assess the prevalence of papilledema in patients with isolated craniosynostosis. Second, we wanted to assess if the presence of ventricular dilatation on computed tomography (CT) scan is a predictive factor for the occurrence of papilledema. We included 205 consecutive children with an isolated single-suture craniosynostosis, who had at least 1 fundus examination. Preoperative CT scans of the brain were examined for the presence of ventricular dilatation.Papilledema developed in 14 of 205 patients: 10 developed papilledema before surgery and 4 during the follow-up period. Ten of the patients with papilledema had a synostosis of the sagittal suture, and 4 of the metopic suture. Prevalence of papilledema in scaphocephaly was 9.7%, and in trigonocephaly, 5.6%. Based on evaluation of all CT scans, ventricular dilatation seemed not to be a predictive factor for papilledema in children with isolated craniosynostosis.The incidence of papilledema in almost 10% of scaphocephaly patients is remarkably higher than expected. Therefore, we recommend routine preoperative screening, especially for patients with scaphocephaly, but also for patients with trigonocephaly. Postoperative screening is recommended in all patients when there is any uncertainty.

Metopic synostosis: Measuring intracranial volume change following fronto-orbital advancement using three-dimensional photogrammetry

“…It is well documented, that a subset of non-syndromic suture fusion patients show an elevated intracranial pressure (ICP) with a potential negative impact on brain development (Florisson et al, 2010). However, the exact relationship between ICP, intracranial volume and impaired brain development remains unclear.…”

Newer Understanding of Eye Issues in Craniofacial Malformations

“…In a recent retrospective study on the prevalence of papilledema in 205 patients with single suture craniosynostosis, papilledema was noted in 9.7 % of sagittal suture synostosis, 5.6 % in the metopic suture group and no papilledema seen in patients with coronal or lambdoidal suture synostosis [7]. This study highlights the importance of optic nerve assessments in single suture craniosynostosis.…”

“…The majority of articles are retrospective case series with a small number of patients, limited follow-up, and varying quantitative and qualitative descriptions of ocular findings. Furthermore, data on ocular findings are often limited, and longitudinal follow-up of patients before and after craniofacial repair is often not reported [7].…”

Surgical outcome after using a modified technique of the pi-procedure for posterior sagittal suture closure

“…Renier et al reported an increased ICP in 14% in scaphocephaly (Renier et al, 2000). Florisson et al reported about a prevalence of papilloedema in scaphocephaly of 9.7% (Florisson et al, 2010) and Taylor et al found a relationship between abnormalities of venous drainage and increased ICP in children with syndromic craniosynostosis (Taylor et al, 2001).…”

“…Increased ICP can be identified clinically by fundus examination as papilloedema or optic atrophy (Florisson et al, 2010). The prevalence of elevated ICP in nonsyndromic craniosynostosis differs according to the affected suture.…”