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Unicoronal Craniosynostosis: Is There a Lateral Difference in Retinal Morphology?
Christopher L Kalmar1, Anna R Carlson1, Zachary D Zapatero1
1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia.
The Journal of Craniofacial Surgery
|May 31, 2021
Summary
In pediatric craniosynostosis, elevated intracranial pressure is not uniform. Retinal nerve fiber layer thickness shows a rotational pattern, suggesting differential pressure transmission or retinal morphology changes.
Area of Science:
- Pediatric Neurosurgery
- Ophthalmology
- Cranial Surgery
Background:
- Craniosynostosis involves premature cranial suture fusion in children, potentially causing elevated intracranial pressure.
- The distribution of this increased intracranial pressure within the cranial vault is not fully understood.
Purpose of the Study:
- To investigate the localized effects of intracranial pressure in pediatric craniosynostosis.
- To determine if elevated intracranial pressure is uniformly distributed or localized near fused sutures.
Main Methods:
- Utilized Optical Coherence Tomography (OCT) for noninvasive measurement of peripapillary retinal nerve fiber layer (RNFL) thickness.
- Compared RNFL thickness in eyes ipsilateral versus contralateral to unicoronal suture fusion in pediatric patients.
Main Results:
- Analyzed 21 pediatric patients undergoing surgical correction for craniosynostosis.
- Observed a 45° circumferential rotation in RNFL thickness patterns, indicating a 'rotation phenomenon' rather than a simple increase on the affected side.
- This rotation was observed in the direction of intorsion.
Conclusions:
- The observed RNFL changes suggest differential transmission of intracranial changes to the peripapillary retina.
- Alternatively, differing retinal morphology between ipsilateral and contralateral eyes may explain the findings.
- Further research is needed to elucidate the exact mechanisms behind these observed phenomena.
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