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Use of neuroimaging measurements of optic nerve sheath diameter to assess intracranial pressure in craniosynostosis

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Abstract

Purpose

This study aims to evaluate accuracy of optic nerve sheath diameter (ONSD) measurements obtained by magnetic resonance imaging (MRI) in patients with craniosynostosis (CS) for detection of high intracranial pressure (ICP) and to correlate MRI-derived ONSD measurements with those obtained by computed tomography (CT) scans in CS patients.

Methods

A retrospective review was conducted on CS patients who had MRI- and age-matched controls with normal MRI. Diagnosis of intracranial hypertension was based on presence of papilledema, direct ICP monitoring, and/or lumbar puncture. The search also included patients with MRI and CT done within 30 days apart. ONSDs were measured 3 mm behind the globe on both modalities.

Results

The study identified 56 CS patients (mean age 3.8 ± 3.47 years) and 49 controls (mean age 3.7 ± 3.62 years). Mean ONSD in patients with high ICP was significantly higher than in patients without high ICP (P = 0.0001) and in controls (P < 0.0001). The optimal ONSD threshold for predicting raised ICP in patients >1 year old was 6 mm (71.4% sensitivity, 89.7% specificity). Nineteen patients with 38 single-eye MRI/CT pairs were identified. Substantial agreement between both modalities resulted (r = 0.959, 95% CI 0.923–0.978), and Bland and Altman Plot analysis showed that 95% of measurements fell within limits of agreement (1.96 SD; ± 0.6 mm).

Conclusion

In CS patients, ONSD measured by MRI represent indirect non-invasive means of ICP assessment. Both MRI and CT measurements of ONSD gave comparable results, and the use of CT-derived ONSD measurements may give some idea about ICP in CS patients.

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Author information

Authors and Affiliations

  1. Department of Plastic Surgery – Cleft-Craniofacial Center, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, 15224, USA

    Mostafa Haredy & Jesse A. Goldstein

  2. Plastic Surgery Department – Cleft and Craniofacial Unit, Sohag University Hospital, Sohag, 82524, Egypt

    Mostafa Haredy

  3. Department of Radiology, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Giulio Zuccoli

  4. Department of Neurosurgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Mandeep Tamber

  5. Department of Ophthalmology, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Amani Davis & Ken Nischal

Authors
  1. Mostafa Haredy
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  2. Giulio Zuccoli
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  3. Mandeep Tamber
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  4. Amani Davis
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  5. Ken Nischal
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  6. Jesse A. Goldstein
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Corresponding author

Correspondence to Mostafa Haredy.

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The study was approved by the institutional review board.

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The authors have no potential conflict of interest.

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Haredy, M., Zuccoli, G., Tamber, M. et al. Use of neuroimaging measurements of optic nerve sheath diameter to assess intracranial pressure in craniosynostosis. Childs Nerv Syst 34, 939–946 (2018). https://doi.org/10.1007/s00381-018-3728-7

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  • DOI: https://doi.org/10.1007/s00381-018-3728-7

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