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Early Recognition of Raised Intracranial Pressure in Craniosynostosis Using Optical Coherence Tomography
Sohaib R Rufai1,2, Noor Ul Owase Jeelani3,4, Rebecca J McLean1
1University of Leicester Ulverscroft Eye Unit, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester.
Insights
Optical coherence tomography (OCT) shows promise for detecting raised intracranial pressure (ICP) in children with craniosynostosis. However, current evidence quality is low, necessitating further research to validate OCT
Area of Science:
- Pediatric Ophthalmology
- Neurosurgery
- Medical Imaging
Background:
- Craniosynostosis can lead to dangerous increases in intracranial pressure (ICP) in children.
- Direct ICP measurement is invasive and risky.
- Noninvasive methods for estimating ICP are needed.
Purpose of the Study:
- To systematically review the use of optical coherence tomography (OCT) for detecting raised ICP in pediatric craniosynostosis.
- To evaluate OCT's sensitivity and specificity compared to other diagnostic methods.
Main Methods:
- Systematic literature review of studies published until August 19, 2019.
- Included children aged 0-16 years with craniosynostosis.
- Assessed quality using the NIH Quality Assessment Tool.
Main Results:
- Only 3 studies met inclusion criteria; 2 were poor quality, 1 was fair.
- OCT showed higher sensitivity and specificity than fundus examination, clinical history, radiology, and visual field testing.
Conclusions:
- Limited high-quality evidence supports OCT as a screening tool for raised ICP in pediatric craniosynostosis.
- Further research is needed to establish OCT's role and optimal parameters.
Objective:
Craniosynostosis can be associated with raised intracranial pressure (ICP), which can pose deleterious effects on the brain and vision if untreated. Estimating ICP in children is challenging, whilst gold standard direct intracranial measurement of ICP is invasive and carries risk. This systematic review aims to evaluate the role of optical coherence tomography (OCT), a noninvasive imaging technique, for detecting raised ICP in children with craniosynostosis.
Methods:
The authors conducted a systematic review of the literature published from inception until 19 August, 2019 in the Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, and EMBASE. Eligible studies evaluated the role of OCT in detecting raised ICP in children aged 0 to 16 years with craniosynostosis. Main outcome measures were sensitivity and specificity of OCT parameters for raised ICP. Quality assessment was performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies.
Results:
Out of 318 records identified, data meeting the inclusion criteria were obtained from 3 studies. The quality of 2 studies was poor whilst 1 was fair. Optical coherence tomography demonstrated higher sensitivity and specificity for detecting raised ICP compared to fundus examination, clinical history, radiological testing, and visual field testing.
Conclusions:
This systematic review demonstrated a lack of quality evidence for OCT as a screening tool for children with craniosynostosis. Further research is required to clarify the strength of OCT in this role and to determine which OCT parameters are most appropriate.
