Top

Published in:

01-03-2020 | Intracranial Hypertension | Original Article

Intracranial pressure patterns in children with craniosynostosis utilizing optical coherence tomography

Authors: Jordan W. Swanson, Wen Xu, Gui-Shuang Ying, Wei Pan, Shih-Shan Lang, Gregory G. Heuer, Scott P. Bartlett, Jesse A. Taylor

Published in: Child's Nervous System | Issue 3/2020

Abstract

Background

Better understanding the incidence and patterns of elevated intracranial pressure (ICP) in patients with craniosynostosis may facilitate more timely intervention to alter neurocognitive outcomes. Spectral-domain optical coherence tomography (OCT) of the retina can non-invasively diagnose elevated ICP, and has demonstrated high sensitivity and specificity among patients with craniosynostosis. This study sought to characterize patterns of elevated ICP among patients with craniosynostosis.

Methods

Quantitative retinal parameters were prospectively assessed in both eyes of patients with craniosynostosis using spectral-domain OCT. Based on retinal OCT thresholds associated with elevated ICP (> 15 mmHg), subjects were assigned an OCT diagnosis of elevated or non-elevated ICP which was analyzed relative to clinical characteristics and craniosynostosis patterns.

Results

Eighty subjects (aged 0.2–18 years) with craniosynostosis were enrolled; among these, 67 (84%) were nonsyndromic. OCT evaluation was performed at initial vault expansion in 56 (70%) patients. Among this subset, 27 (48%) patients had peri-papillary changes suggestive of elevated ICP, reflecting a 44% incidence in nonsyndromic and 83% in syndromic patients. The median age at initial vault expansion was higher among those with elevated ICP (11.1 months) than those without (7.8 months; p = 0.04.) Multi-suture synostosis was associated with changes consistent with elevated ICP in 9 (75%) patients compared with 18 (41%) with single suture synostosis (p = 0.05).

Conclusions

OCT of the retina produces a potentially sensitive indicator of ICP in craniosynostosis patients. Elevated ICP may be associated with number of involved sutures and older patient presentation, and refining appropriate “cutoffs” will be important as the technology becomes more widespread.

Renier D, Sainte-Rose C, Marchac D, Hirsch JF (1982) Intracranial pressure in craniostenosis. J Neurosurg 57(3):370–377CrossRefPubMed

Wall SA, Thomas GPL, Johnson D, Byren JC, Jayamohan J, Magdum SA, McAuley D, Richards PG (2014) The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature. J Neurosurg Pediatr 14(6):674–681CrossRefPubMed

Gault DT, Renier D, Marchac D, Jones BM (1992) Intracranial pressure and intracranial volume in children with craniosynostosis. Plast Reconstr Surg 90(3):377–381CrossRefPubMed

Thompson DN, Harkness W, Jones B, Gonsalez S, Andar U, Hayward R (1995) Subdural intracranial pressure monitoring in craniosynostosis: its role in surgical management. Childs Nerv Syst 11(5):269–275CrossRefPubMed

Eley KA, Johnson D, Wilkie AOM, Jayamohan J, Richards P, Wall SA (2012) Raised intracranial pressure is frequent in untreated nonsyndromic unicoronal synostosis and does not correlate with severity of phenotypic features. Plast Reconstr Surg 130(5):690e–697eCrossRefPubMed

Spruijt B, Joosten KFM, Driessen C, Rizopoulos D, Naus NC, van der Schroeff M, Wolvius EB, van Veelen M, Tasker RC, Mathijssen IM (2015) Algorithm for the management of intracranial hypertension in children with syndromic craniosynostosis. Plast Reconstr Surg 136(2):331–340CrossRefPubMed

Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R (1977) The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47(4):491–502CrossRefPubMed

Marshall LF, Smith RW, Shapiro HM (1979) The outcome with aggressive treatment in severe head injuries. Part II: acute and chronic barbiturate administration in the management of head injury. J Neurosurg 50(1):26–30CrossRefPubMed

Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T, Global Neurotrauma Research Group (2012) A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 367(26):2471–2481CrossRefPubMedPubMedCentral

10.

Patel A, Yang JF, Hashim PW et al (2014) The impact of age at surgery on long-term neuropsychological outcomes in sagittal craniosynostosis. Plast Reconstr Surg 134(4):608e–617eCrossRefPubMed

11.

Hashim PW, Patel A, Yang JF, Travieso R, Terner J, Losee JE, Pollack I, Jane J Sr, Jane J Jr, Kanev P, Mayes L, Duncan C, Bridgett DJ, Persing JA (2014) The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis. Plast Reconstr Surg 134(3):491–501CrossRefPubMed

12.

Pollack IF, Losken HW, Biglan AW (1996) Incidence of increased intracranial pressure after early surgical treatment of syndromic craniosynostosis. Pediatr Neurosurg 24(4):202–209CrossRefPubMed

13.

de Jong T, Bannink N, Bredero-Boelhouwer HH et al (2010) Long-term functional outcome in 167 patients with syndromic craniosynostosis; defining a syndrome-specific risk profile. J Plast Reconstr Aesthet Surg 63(10):1635–1641CrossRefPubMed

14.

Tuite G, Chong WK, Evanson J, Narita A, Taylor D, Harkness WF, Jones BM, Hayward RD (1996) The effectiveness of papilledema as an indicator of raised intracranial pressure in children with craniosynostosis. Neurosurgery. 38(2):272–278CrossRefPubMed

15.

Nazir S, O’Brien M, Qureshi NH, Slape L, Green TJ, Phillips PH (2009) Sensitivity of papilledema as a sign of shunt failure in children. J AAPOS 13(1):63–66CrossRefPubMed

16.

Rangwala L, Liu G (2007) Pediatric idiopathic intracranial hypertension. Surv Ophthalmol 52(6):597–617CrossRefPubMed

17.

Teismann N, Lenaghan P, Nolan R, Stein J, Green A (2013) Point-of-care ocular ultrasound to detect optic disc swelling. Acad Emerg Med 20(9):920–925CrossRefPubMed

18.

Bolesch S, von Wegner F, Senft C, Lorenz MW (2015) Transcranial ultrasound to detect elevated intracranial pressure: comparison of septum pellucidum undulations and optic nerve sheath diameter. Ultrasound Med Biol 41(5):1233–1240CrossRefPubMed

19.

Kimberly HH, Shah S, Marill K, Noble V (2008) Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 15(2):201–204CrossRefPubMed

20.

Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B (2011) Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 37(7):1059–1068CrossRefPubMed

21.

Driessen C, Bannink N, Lequin M, van Veelen M, Naus NC, Joosten KF, Mathijssen IM (2011) Are ultrasonography measurements of optic nerve sheath diameter an alternative to funduscopy in children with syndromic craniosynostosis? J Neurosurg Pediatr 8(3):329–334CrossRefPubMed

22.

Driessen C, van Veelen M-LC, Lequin M, Joosten KFM, Mathijssen IMJ (2012) Nocturnal ultrasound measurements of optic nerve sheath diameter correlate with intracranial pressure in children with craniosynostosis. Plast Reconstr Surg 130(3):448e–451eCrossRefPubMed

23.

Kristiansson H, Nissborg E, Bartek J, Andresen M, Reinstrup P, Romner B (2013) Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol 25(4):372–385CrossRefPubMed

24.

Raboel PH, Bartek J, Andresen M, Bellander BM, Romner B (2012) Intracranial pressure monitoring: invasive versus non-invasive methods-a review. Crit Care Res Pract 2012:950393PubMedPubMedCentral

25.

Wiegand C, Richards P (2007) Measurement of intracranial pressure in children: a critical review of current methods. Dev Med Child Neurol 49(12):935–941CrossRefPubMed

26.

Skau M, Yri H, Sander B, Gerds TA, Milea D, Jensen R (2012) Diagnostic value of optical coherence tomography for intracranial pressure in idiopathic intracranial hypertension. Graefes Arch Clin Exp Ophthalmol:567–574

27.

Yri HM, Wegener M, Sander B, Jensen R (2011) Idiopathic intracranial hypertension is not benign: a long-term outcome study. J Neurol 259(5):886–894CrossRefPubMed

28.

Kaufhold F, Kadas EM, Schmidt C, Kunte H, Hoffmann J, Zimmermann H, Oberwahrenbrock T, Harms L, Polthier K, Brandt AU, Paul F (2012) Optic nerve head quantification in idiopathic intracranial hypertension by spectral domain OCT. PLoS One 7(5):e36965CrossRefPubMedPubMedCentral

29.

Aleman TS, Soumittra N, Cideciyan AV et al (2009) CERKL mutations cause an autosomal recessive cone-rod dystrophy with inner retinopathy. Investig Opthalmol Vis Sci 50(12):5944CrossRef

30.

Heidary G, Rizzo JF Use of optical coherence tomography to evaluate papilledema and pseudopapilledema. Semin Ophthalmol 25(5-6):198–205

31.

Swanson JW, Aleman TS, Xu W, Ying GS, Pan W, Liu GT, Lang SS, Heuer GG, Storm PB, Bartlett SP, Katowitz WR, Taylor JA (2017) Evaluation of optical coherence tomography to detect elevated intracranial pressure in children. JAMA Ophthalmol 135(4):320–328CrossRefPubMedPubMedCentral

32.

Curcio CA, Messinger JD, Sloan KR, Mitra A, McGwin G, Spaide RF (2011) Human chorioretinal layer thicknesses measured in macula-wide, high-resolution histologic sections. Invest Ophthalmol Vis Sci 52(7):3943–3954CrossRefPubMedPubMedCentral

33.

Tamburrini G, Caldarelli M, Massimi L, Santini P, Di Rocco C (2005) Intracranial pressure monitoring in children with single suture and complex craniosynostosis: a review. Childs Nerv Syst 21(10):913–921CrossRefPubMed

34.

Selber J, Reid RR, Chike-Obi CJ, Sutton LN, Zackai EH, McDonald-McGinn D, Sonnad SS, Whitaker LA, Bartlett SP (2008) The changing epidemiologic spectrum of single-suture synostoses. Plast Reconstr Surg 122(2):527–533CrossRefPubMed

35.

Hayward R, Britto J, Dunaway D, Jeelani O. Connecting raised intracranial pressure and cognitive delay in craniosynostosis: many assumptions, little evidence. Journal of Neurosurgery: Pediatrics. 2016 Aug 1;18(2):242–50

36.

Avery RA, Shah SS, Licht DJ, Seiden JA, Huh JW, Boswinkel J, Ruppe MD, Chew A, Mistry RD, Liu GT (2010) Reference range for cerebrospinal fluid opening pressure in children. N Engl J Med 363(9):891–893CrossRefPubMedPubMedCentral

37.

Minns RA (1984) Intracranial pressure monitoring. Arch Dis Child 59(5):486–488CrossRefPubMedPubMedCentral

38.

Thomas GPL, Johnson D, Byren JC, Judge AD, Jayamohan J, Magdum SA, Richards PG, Wall SA (2015) The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery. J Neurosurg Pediatr 15(4):350–360CrossRefPubMed

39.

Gospe SM, Bhatti MT, El-Dairi MA (2017) Emerging applications of optical coherence tomography in pediatric optic neuropathies. Semin Pediatr Neurol 24(2):135–142CrossRefPubMed

40.

Utria AF, Lopez J, Cho RS, Mundinger GS, Jallo GI, Ahn ES, Kolk CV, Dorafshar AH (2016) Timing of cranial vault remodeling in nonsyndromic craniosynostosis: a single-institution 30-year experience. J Neurosurg Pediatr 18(5):629–634CrossRefPubMed

41.

Layliev J, Gill R, Spear M, Cifuentes J, Wang L, Kelly KJ (2016) The optimal timing for primary cranial vault reconstruction in nonsyndromic craniosynostosis. J Craniofac Surg 27(6):1445–1452CrossRefPubMed

42.

Pagnoni M, Fadda MT, Spalice A et al (2014) Surgical timing of craniosynostosis: what to do and when. J Cranio-Maxillofacial Surg 42(5):513–519CrossRef

43.

Kapp-Simon KA, Speltz ML, Cunningham ML, Patel PK, Tomita T (2007) Neurodevelopment of children with single suture craniosynostosis: a review. Childs Nerv Syst 23(3):269–281CrossRefPubMed

44.

Chang RO, Marshall BK, Yahyavi N, Sharma A, Huecker J, Gordon MO, McClelland C, van Stavern G (2016) Neuroimaging features of idiopathic intracranial hypertension persist after resolution of papilloedema. Neuroophthalmology. 40(4):165–170CrossRefPubMedPubMedCentral

Title: Intracranial pressure patterns in children with craniosynostosis utilizing optical coherence tomography
Authors: Jordan W. Swanson
Wen Xu
Gui-Shuang Ying
Wei Pan
Shih-Shan Lang
Gregory G. Heuer
Scott P. Bartlett
Jesse A. Taylor
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Keywords: Intracranial Hypertension
Craniosynostosis
Published in: Child's Nervous System / Issue 3/2020
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-019-04448-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Intracranial pressure patterns in children with craniosynostosis utilizing optical coherence tomography

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2020

Does ventricular volume affect the neurodevelopmental outcome in infants with intraventricular hemorrhage?

Diffuse leptomeningeal glioneuronal tumour (DLGNT) with hydrocephalus as an initial symptom: a case-based update

Ultrasound-guided percutaneous ventriculopleural shunt placement: a minimally invasive technique

Systematic review and meta-analysis of imaging characteristics in Chiari I malformation: does anything really matter?

Meet in the middle: a technique for resecting nasocranial dermoids—technical note and review of the literature

Hydroxyapatite ceramic implants for cranioplasty in children: a retrospective evaluation of clinical outcome and osteointegration