Sagittal Craniosynostosis: Incidence of Elevated Intracranial Pressure during Early Intervention
Christopher L. Kalmar, Elizabeth L. Malphrus, Mychajlo S. Kosyk, Zachary D. Zapatero, Scott P. Bartlett, Jesse A. Taylor, Jordan W. Swanson
Children's Hospital of Philadelphia, Philadelphia, PA
Introduction: Optical coherence tomography (OCT) of the peripapillary retina is a recently validated noninvasive quantitative modality to assess ICP in pediatric patients with craniosynostosis. The primary purpose of this study was to utilize OCT to assess the incidence of elevated ICP in infants undergoing surgical correction for isolated sagittal craniosynostosis. A secondary objective was to assess relationship between severity of scaphocephaly and ICP.
Methods: OCT measurements were obtained in patients undergoing surgery for sagittal craniosynostosis. OCT parameters analyzed included the maximal retinal nerve fiber layer thickness (MaxRNFL) and maximal anterior projection (MaxAP) using the OCT cross-section that corresponded most closely to the center of the optic disc. Previous investigation demonstrated that OCT parameters for predicting ICP elevation above 15 mmHg required MaxRNFL thickness of 159.8 ??m and MaxAP of 129.1 ??m. This combination yielded a sensitivity of 77.3% and specificity of 95.0%. Previous investigation demonstrated that OCT parameters for predicting ICP elevation above 20 mmHg required MaxRNFL thickness of 170.6 ??m and MaxAP of 138.3 ??m. This combination yielded a sensitivity of 90.0% and specificity of 81.3%.
Results: Seventy-two patients underwent corrective surgery for sagittal craniosynostosis with OCT scans available. There were 48.6% patients younger than 6 months of age, 15.3% patients were between 6-12 months of age, and 36.1% patients were 12 months of age or older. Retinal parameter measurements demonstrated ICP <15 mmHg in 88.6% (n=31 of 35) patients <6 months of age. Compared to these children, significantly fewer patients between 6-12 months of age (54.5%, n=6 of 11, p=.025) and ?12 months of age (46.2%, n=12 of 26, p<.001) had ICP <15 mmHg. Retinal parameter measurements demonstrated ICP <20 mmHg in 91.4% (n=32 of 35) patients <6 months of age. Compared to these children, significantly fewer patients between 6-12 months of age (54.5%, n=6 of 11, p=.013) and ?12 months of age (53.8%, n=14 of 26, p=.001) had ICP <20 mmHg. Intracranial pressure was never checked directly in patients younger than 6 months of age, but was obtained via durotomy in 25 older patients. Directly measured intracranial pressure was inversely correlated to cephalic index (p=.009), such that patients with more severe scaphocephaly had higher intracranial pressure.
Conclusions: The vast majority of patients undergoing early intervention (<6 months of age) for nonsyndromic sagittal craniosynostosis do not have elevated intracranial pressure by OCT measurement.
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