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

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.