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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

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Peripapillary Hyperreflective Ovoid Mass-like Structures before and after Intracranial Decompression: A Longitudinal

Yoon-Hee Chang¹, Ryan Gise¹, Tais Estrela¹

¹Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

|July 30, 2025

Summary

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) strongly predict the need for intracranial pressure (ICP) decompression surgery. PHOMS resolution is highly associated with successful ICP decompression, serving as a non-invasive indicator.

Keywords:

Craniosynostosis Intracranial pressure OCT PHOMS Peripapillary hyperreflective ovoid mass-like structures

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Published on: April 24, 2020

Area of Science:

Ophthalmology
Neurosurgery
Medical Imaging

Background:

Syndromic craniosynostosis often leads to elevated intracranial pressure (ICP).
Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are observed on optical coherence tomography (OCT) scans.
The clinical significance of PHOMS in relation to ICP management is not fully understood.

Purpose of the Study:

To evaluate the association between PHOMS and the requirement for ICP decompression surgery.
To assess the impact of ICP decompression surgery on the persistence of PHOMS.

Main Methods:

Retrospective longitudinal cohort study of 34 patients with syndromic craniosynostosis.
Analysis of consecutive OCT volume scans by neuro-ophthalmologists to identify PHOMS.
Review of demographic, ophthalmic, and surgical data, including ICP decompression procedures.

Main Results:

PHOMS presence showed 85.7% sensitivity and 70.4% specificity for predicting ICP decompression surgery.
The odds of needing ICP decompression surgery were significantly higher (OR 14.3:1) in patients with PHOMS.
PHOMS resolution occurred in 83.3% of patients who underwent ICP decompression versus 0% in those who did not.

Conclusions:

PHOMS presence is a significant predictor of the need for ICP decompression surgery.
Absence of PHOMS suggests ICP decompression is unlikely to be indicated.
PHOMS resolution after surgery indicates successful ICP management and may serve as a non-invasive monitoring tool.