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Optical Coherence Tomography: A New Modality for Detecting Papilledema in Craniosynostosis Patients with Suspected Intracranial Hypertension
Jordan Swanson, MD, MSc1, Lloyd Bender, MD, MSc1, Brianne Mitchell, MD2, Greg Heuer, MD1, William Katowitz, MD1, Jesse Taylor, MD1.
1Univ of Pennsylvania, Philadelphia, PA, USA, 2University of Pennsylvania, Philadelphia, PA, USA.

PURPOSE:
Detecting intracranial hypertension in children with craniosynostosis may enable earlier intervention to prevent neurocognitive impairment, but is invasive and frequently equivocal with conventional methods. Optical coherence tomography (OCT) can noninvasively quantify optic disc thickness with high resolution using ultrasound. We aim to determine whether OCT can be reliably used to measure retinal thickness of infants with craniosynostosis, and whether findings correlate with clinical indications of papilledema and intracranial hypertension.
METHODS:
Children diagnosed with craniosynostosis who underwent cranial vault remodeling were evaluated. 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. Patient characteristics, clinical findings, and ophthalmologic evaluations were reviewed.
RESULTS:
Twenty-two retinas in eleven children with craniosynostosis underwent OCT prior to cranial vault remodeling, at a median age of 9 months (range 3 months-12 years.) Twenty-one retinas were imaged successfully (95%) in a mean time of 21 minutes. Fifteen retinas (8 patients) were found to have normal optic nerve thickness and surface characteristics. Six retinas (3 patients) revealed abnormally thickened optic discs bilaterally. Two of these patients (66%) exhibited symptoms (headaches) or radiographic findings (thumbprinting) associated with increased intracranial pressure, but one (33%) had no prior findings. In this patient intracranial pressure was elevated on opening but decreased to normal after frontal bone removal.
CONCLUSION:
Optical coherence tomography is a feasible modality for objectively measuring retinal thickness in infants with craniosynostosis, and may enable earlier detection of intracranial hypertension.


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