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Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Quantitative CT Imaging Features Associated With High Risk of Elevated Intracranial Pressure in Children Under 2
Yuzhu Zhu1, Min Ji2, Chenbin Dong1
1Department of Plastic Surgery, Children's Hospital of Fudan University, National Children's Medical Center.
Insights
Quantitative CT scans can identify elevated intracranial pressure in infants with craniosynostosis. Optic nerve sheath diameter and cranial bone thickness on CT scans may help screen young children for this condition.
Area of Science:
- Pediatric Neurosurgery
- Medical Imaging
- Craniosynostosis Research
Background:
- Elevated intracranial pressure (ICP) is a significant complication in craniosynostosis, impacting surgical planning.
- Invasive ICP monitoring poses risks for infants and young children.
- Noninvasive imaging markers are needed for early identification of elevated ICP.
Purpose of the Study:
- To evaluate quantitative computed tomography (CT) parameters as noninvasive markers for elevated ICP in young children with craniosynostosis.
- To compare CT findings in children with craniosynostosis at high risk for elevated ICP against age- and sex-matched controls.
Main Methods:
- Retrospective analysis of cranial CT images from 36 children under 2 years with craniosynostosis and 24 controls.
- Exclusion of patients with hydrocephalus, traumatic brain injury, or other ICP-increasing lesions.
- Measurement of optic nerve sheath diameter (ONSD), skull base thickness, and calvarial thickness on CT images.
Main Results:
- Children with craniosynostosis showed significantly larger ONSD and thinner skull base and calvarium compared to controls (P<0.001).
- Nonsyndromic group: mean ONSD 4.96 mm, skull base 3.11 mm, calvarium 1.99 mm.
- Syndromic group: mean ONSD 4.79 mm, skull base 3.19 mm, calvarium 1.97 mm.
Conclusions:
- Children under 2 with craniosynostosis at high risk for elevated ICP exhibit CT findings of optic nerve sheath enlargement and cranial bone thinning.
- Combined assessment of ONSD and cranial bone thickness on CT can aid noninvasive preoperative screening and risk stratification.
- CT parameters offer a valuable noninvasive adjunct for managing pediatric craniosynostosis.
Objective:
Elevated intracranial pressure (ICP) is an important complication of craniosynostosis, and early identification may help optimize surgical planning and treatment. Although invasive ICP monitoring remains the reference standard, its routine use in infants and young children is limited by procedural risks. This study aimed to evaluate whether quantitative computed tomography (CT) parameters could serve as noninvasive imaging markers associated with a high risk of elevated ICP in children under 2 years of age with craniosynostosis, compared with age- and sex-matched controls.
Methods:
The authors retrospectively analyzed cranial CT images from 36 children under 2 years of age with craniosynostosis who were classified as having a high risk of elevated ICP according to a previously published clinical prediction rule (20 nonsyndromic and 16 syndromic cases), along with 24 age- and sex-matched control children. Patients with hydrocephalus, traumatic brain injury, or other intracranial space-occupying lesions known to increase ICP were excluded. Quantitative CT parameters, including optic nerve sheath diameter (ONSD), skull base thickness, and calvarial thickness, were measured on axial and coronal images and compared between groups.
Results:
A total of 36 children with craniosynostosis and 24 control children were included. Both nonsyndromic and syndromic craniosynostosis groups demonstrated significant differences in mean ONSD, skull base thickness, and calvarial thickness compared with controls (all P <0.001). Specifically, compared with controls, the nonsyndromic group showed a larger mean ONSD (4.96 versus 3.90 mm), thinner skull base (3.11 versus 3.85 mm), and thinner calvarium (1.99 versus 2.85 mm). Similarly, the syndromic group exhibited increased ONSD (4.79 versus 3.90 mm), reduced skull base thickness (3.19 versus 3.85 mm), and reduced calvarial thickness (1.97 versus 2.85 mm) (all P <0.001). No statistically significant differences in these CT parameters were observed between the nonsyndromic and syndromic groups.
Conclusions:
Children under 2 years of age with craniosynostosis who are classified as being at high risk of elevated ICP demonstrate characteristic CT findings, including optic nerve sheath enlargement and thinning of the skull base and calvarium. The combined assessment of ONSD and cranial bone thickness on CT may serve as a useful noninvasive adjunct for preoperative screening and risk stratification in young children with craniosynostosis.
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