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Changes in Mamillopontine Distance and Pontomesencephalic angle following Treatment for Pediatric Idiopathic
Sadullah Şimşek1, Tülin Savaş2, Tarık Sağlam1
1Diyarbakır SBU Gazi Yaşargil Training and Research Hospital, Radiology Department, Turkey, Diyarbakır.
Insights
Pediatric idiopathic intracranial hypertension (IIH) can be monitored using MRI measurements. The mammillopontine distance and pontomesencephalic angle show significant changes after treatment, making them useful markers for follow-up.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Pediatric idiopathic intracranial hypertension (IIH) lacks objective, noninvasive markers for diagnosis and monitoring.
- Current diagnostic and follow-up methods for pediatric IIH can be invasive or subjective.
Purpose of the Study:
- To evaluate if mammillopontine distance and pontomesencephalic angle, measured via MRI, reflect treatment-related changes in pediatric IIH.
- To determine the utility of these measurements as potential objective markers for IIH management.
Main Methods:
- A retrospective study involving 40 children (20 with pediatric IIH, 20 controls) aged 5-15 years.
- MRI scans were performed before and after treatment for pediatric IIH patients, and serially for controls.
- Mammillopontine distance and pontomesencephalic angle were measured on sagittal T2-weighted images by three radiologists.
Main Results:
- Pediatric IIH patients had significantly lower mammillopontine distance and pontomesencephalic angle compared to controls before treatment.
- Following treatment (lumbar puncture, acetazolamide), both mammillopontine distance and pontomesencephalic angle significantly increased.
- The pontomesencephalic angle demonstrated a more pronounced change post-treatment, suggesting higher responsiveness.
Conclusions:
- Mammillopontine distance and pontomesencephalic angle are reproducible MRI markers that reflect treatment-related changes in pediatric IIH.
- These measurements show potential as objective, noninvasive tools for monitoring treatment response and disease progression in pediatric IIH.
- The pontomesencephalic angle may be a more sensitive indicator for tracking treatment efficacy compared to mammillopontine distance.
Background:
Pediatric idiopathic intracranial hypertension requires objective, noninvasive markers for diagnosis and follow-up. We aimed to determine whether mammillopontine distance and pontomesencephalic angle, two simple sagittal MRI measurements, reflect treatment-related changes.
Methods:
This retrospective study included 40 children aged 5 to 15 years: 20 patients with idiopathic intracranial hypertension and 20 age-matched controls. Idiopathic intracranial hypertension diagnosis was based on clinical/radiological findings and a cerebrospinal fluid opening pressure of>28 cmH2O. All idiopathic intracranial hypertension patients underwent lumbar puncture with therapeutic cerebrospinal fluid drainage and acetazolamide therapy, with magnetic resonance imaging performed before treatment and after complete clinical and radiological resolution. Controls had normal cerebrospinal fluid pressure and normal serial magnetic resonance imaging findings. The mammillopontine distance and pontomesencephalic angle were measured on sagittal T2-weighted images by three experienced radiologists. Statistical analyses were performed using SPSS, with p<0.05 considered significant; inter-rater reliability was assessed using the intraclass correlation coefficient.
Results:
Age and sex were comparable between groups. Before treatment, the pontomesencephalic angle and mammillopontine distance were significantly lower in the idiopathic intracranial hypertension group than in controls (both p<0.001), while the cerebrospinal fluid pressure was significantly higher (p<0.001). After treatment, the mammillopontine distance increased by a mean of 0.64 mm and the pontomesencephalic angle increased by a mean of 8.88°, accompanied by a mean cerebrospinal fluid pressure reduction of 21.60 mmH2O (all p<0.001). Serial measurements in controls remained unchanged (p>0.050). In controls, repeated-measurement reliability was high (intraclass correlation coefficient=0.970; 95% confidence interval: 0.925-0.988).
Conclusions:
Mammillopontine distance and pontomesencephalic angle demonstrate significant treatment-related changes in pediatric idiopathic intracranial hypertension and may be useful, reproducible magnetic resonance imaging-derived markers for follow-up. Although both parameters increased after therapy, the pontomesencephalic angle showed a more pronounced treatment-related change than the mammillopontine distance, suggesting greater responsiveness for monitoring treatment responses.
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