Intracranial Pressure Patterns In Children With Sagittal Craniosynostosis
Christopher L. Kalmar, MD MBA, Elizabeth Malphrus, MD MBA, Mychajlo S. Kosyk, BA, Zachary D. Zapatero, BS, Anna R. Carlson, MD, Gregory G. Heuer, MD PhD, Scott P. Bartlett, MD, Jesse A. Taylor, MD, Jordan W. Swanson, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
PURPOSE: Elevated intracranial pressure (ICP) in sagittal craniosynostosis has a wide spectrum of reported incidence, and patterns are not well understood across infancy and childhood. Characterizing the natural history of ICP in this population may clarify risks for neurocognitive delay and inform treatment decisions.
METHODS: Infants and children with sagittal craniosynostosis (SC) and unaffected control subjects were prospectively evaluated with spectral-domain optical coherence tomography (OCT) from 2014-2021. Elevated ICP was determined based on previously validated algorithms utilizing retinal OCT parameters. Severity of scaphocephaly and other patient characteristics were abstracted and analyzed.
RESULTS: Seventy-two patients with SC twenty-five control subjects were evaluated, aged 9 (IQR 3.8-65) months. Twenty-three (32%) patients with SC showed surrogates of ICP above 15 mmHg, and among these 20 (28%) of above 20 mmHg. Children with sagittal craniosynostosis below 6 months of age (88.6%, 91.4%) were more likely to have normal intracranial pressure than those 6-12 months of age (54.5%, p=.025; 54.5%, p=.013) and ≥12 months of age (46.2%, p<.001; 53.8%, p=.001) utilizing 15 mmHg and 20 mmHg as cutoffs respectively. Subjects with mild SC (cephalic index > 0.75) were less likely to have ICP > 15 mmHg (p=0.014.) No control subjects at any age exhibited retinal thickening suggestive of elevated ICP.
CONCLUSION: Elevated ICP is rare in sagittal craniosynostosis below 6 months of age, but appears common after 6 months of age. Risk of elevated ICP also appears to correlate with severity of scaphocephaly. Surgical treatment strategies that mitigate ICP elevation may offer neurocognitive benefit.
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