Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Optical Coherence Tomography to Detect Optic Nerve Pathology in Craniosynostosis Patients with Suspected Intracranial Hypertension
Jordan Swanson, MD, MSc, Lloyd Bender, MD, Brianne Mitchell, MD, Gregory Heuer, MD, PhD, William Katowitz, MD, Jesse Taylor, MD, Michael Mirzabeigi, MD.
University of Pennsylvania, Philadelphia, PA, USA.

PURPOSE:
Identifying intracranial hypertension in children with craniosynostosis may distinguish patients who would benefit from earlier intervention to prevent neurocognitive impairment. However, conventional fundoscopy has low sensitivity for papilledema and poor intraobserver reproducibility while direct transcranial monitoring is highly invasive. Optical coherence tomography (OCT) can noninvasively quantify optic disc thickness with high resolution using ultrasound. We aimed to determine whether OCT could reliably measure retinal characteristics of infants with craniosynostosis, and identify which retinal features best correlate with clinical findings of papilledema and intracranial hypertension.
METHODS:
Children diagnosed with craniosynostosis who underwent cranial vault remodeling were prospectively included. A portable OCT device was used in the operating room to image bilateral fundi. When indicated by the neurosurgical service, patients also underwent direct intracranial pressure measurement before and after craniectomy. Baseline clinical characteristics including preoperative fundoscopy, intraoperative findings, and OCT results were statistically compared.
RESULTS:
Thirty-six retinas in eighteen children with craniosynostosis underwent OCT prior to cranial vault remodeling, at a median age of 8 months (range 3 months-12 years.) Thirty-four retinas were imaged successfully (95%) in a mean time of 12 minutes. Twenty-six retinas (14 patients) were found to have normal optic nerve thickness, volume, and surface characteristics. Eight retinas (4 patients) revealed abnormally thickened optic discs bilaterally. Specific findings that correlated with symptoms of headaches included increased retinal volume within a 1cm radius of the optic disc midpoint, which is a more limited field than the standard retinal nerve fiber layer measurement used in adults. These findings were present in three patients (75%) with symptoms (headaches) or radiographic findings (thumbprinting) associated with increased intracranial pressure, but one (25%) had no prior findings. Three of these patients were also found to have elevated intracranial pressure (22-26 mmHg) on opening which decreased to near normal (mean 12 mmHg) after craniectomy. In contrast, a control patient without symptoms and normal OCT had intracranial pressure of 12 mmHg.
CONCLUSION:
Optical coherence tomography is a feasible modality for objectively measuring retinal characteristics in infants with craniosynostosis. Increased retinal volume within 1cm of the optic disc midpoint is the most sensitive indicator of increased intracranial pressure among these patients, and may enable earlier detection of intracranial hypertension.


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