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Updated: Jul 17, 2025
A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients
Published on: October 17, 2017
Papilloedema: a highly specific predictor of raised intracranial pressure in a complex neurosurgical paediatric
Alexander Mitchell1, Azam Ali Baig2, Usama Kanj2
1Department of Craniofacial Surgery, Birmingham Women and Children's Foundation NHS Trust, Birmingham, United Kingdom. alexander.mitchell1@nhs.net.
Insights
Papilloedema (swelling of the optic disc) is a strong indicator of raised intracranial pressure in children. This finding suggests detailed fundoscopy can help avoid further invasive testing.
Area of Science:
- Paediatric Neurosurgery
- Ophthalmology
- Craniofacial Surgery
Background:
- Papilloedema indicates raised intracranial pressure (ICP).
- Limited data exists on fundoscopy's utility for screening raised ICP in children with craniofacial synostosis.
- Early detection of raised ICP is crucial in paediatric patients.
Purpose of the Study:
- To investigate the association between optic disc morphology and ICP in children.
- To determine the sensitivity and specificity of papilloedema for detecting raised ICP.
- To assess the impact of age and underlying conditions on these findings.
Main Methods:
- Retrospective analysis of 60 paediatric patients (31 with craniofacial synostosis) undergoing ICP monitoring.
- Analysis of fundoscopy findings and ICP monitoring data.
- Comparison of papilloedema presence and ICP levels.
Main Results:
- Papilloedema was a definitive indicator of raised ICP (Positive Predictive Value of 1.00).
- Fundoscopy demonstrated 100% specificity and 48% sensitivity for raised ICP.
- No correlation found between optic disc swelling severity (Frisen grading) and ICP levels; age did not impact findings.
Conclusions:
- Papilloedema is a reliable sign of raised ICP in children, irrespective of the cause.
- Detailed fundoscopy can potentially obviate the need for radiation-associated imaging and invasive ICP monitoring.
Purpose:
Papilloedema is recognised as an indicator of raised intracranial pressure, although there is a paucity of literature describing the utility of fundoscopy in screening for raised ICP in children with craniofacial synostosis, particularly young children. We sought to investigate the association of optic disc morphology with ICP in children, and to define the sensitivity and specificity of papilloedema as a clinical indicator of raised ICP and determine if age, or underlying conditions impact the findings.
Method:
Retrospective analysis of all patients undergoing ICP monitoring at a designated paediatric neurosurgical and craniofacial unit in the United Kingdom between October 2009 and October 2018. The fundoscopy findings and ICP monitoring data were analysed for 31 children with craniosynostosis and 29 children without craniosynostosis.
Results:
All children who had papilloedema had raised ICP confirmed with monitoring. Across the 60-patient cohort, confirmed papilloedema on fundoscopy had Positive Predictive Value (PPV) of 1.00, Negative Predictive Value (NPV) of 0.64 with sensitivity 48% and specificity 100% for the presence of raised ICP (p = < 0.0001). In the craniosynostosis group, PPV was 1.00, NPV was 0.39, sensitivity 48% and specificity 100% (p = < 0.03). There is no correlation between severity of optic disc swelling using Frisen grading and elevation of ICP. Age did not affect the presence of papilloedema in those with raised ICP.
Conclusion:
The presence of papilloedema is a strong indicator of raised ICP in a child, regardless of underlying aetiology. Detailed fundoscopy can prevent the need for further investigations including imaging-related radiation and invasive CSF pressure monitoring.
