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Methodological determinants and prevalence of elevated intracranial pressure in isolated single-suture
Beste Gülsuna1, Parth Patel1, Abdurrahman F Kharbat1
1Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Insights
Elevated intracranial pressure (ICP) affects a significant number of children with single-suture craniosynostosis (SSC). Prevalence estimates vary, highlighting the need for standardized diagnostic methods.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Neurodevelopmental Pediatrics
Background:
- Elevated intracranial pressure (ICP) is a concern in isolated single-suture craniosynostosis (SSC), potentially impacting neurodevelopment.
- Reported prevalence of elevated ICP in isolated SSC varies considerably across studies.
Purpose of the Study:
- To systematically review and meta-analyze the pooled prevalence of elevated ICP in isolated SSC.
- To evaluate potential factors modifying ICP prevalence, including suture subtype, measurement timing, and assessment method.
Main Methods:
- A comprehensive search of major biomedical databases (PubMed, MEDLINE, Embase, Web of Science, Scopus) was conducted.
- Studies reporting ICP outcomes in children with isolated SSC using invasive monitoring or optical coherence tomography (OCT) were included.
- Random-effects meta-analysis with Freeman-Tukey transformation was used to estimate pooled prevalence, stratified by measurement modality.
Main Results:
- Seventeen studies comprising 720 patients were analyzed.
- Pooled prevalence of elevated ICP was 38% (95% CI, 26-51%) via invasive monitoring and 43% (95% CI, 28-61%) via OCT.
- Prevalence did not significantly differ by suture type but appeared higher in intraoperative assessments compared to preoperative.
Conclusions:
- Elevated ICP is prevalent in a substantial proportion of children with isolated SSC, with pooled estimates ranging from 30-50%.
- Diagnostic methodology and assessment timing significantly influence reported prevalence.
- Noninvasive screening with OCT may assist detection; standardized thresholds and further neurocognitive studies are recommended.
Objective:
Elevated intracranial pressure (ICP) in isolated single-suture craniosynostosis (SSC) may contribute to neurodevelopmental impairment, yet reported prevalence varies widely. This systematic review and meta-analysis estimate the pooled prevalence of elevated ICP in isolated SSC and evaluate potential modifiers including suture subtype, measurement timing, and assessment modality.
Methods:
PubMed, MEDLINE, Embase, Web of Science, and Scopus were searched (inception to February 2026). Eligible studies reported ICP outcomes in children with isolated SSC using invasive monitoring or optical coherence tomography (OCT). Pooled prevalence was estimated using random-effects meta-analysis with Freeman-Tukey transformation, stratified by measurement modality (invasive vs. OCT). Subgroup analyses evaluated suture type and measurement timing. Heterogeneity was explored through meta-regression and sensitivity analyses.
Results:
Seventeen studies (720 patients; 1982-2025) met inclusion criteria. All invasive studies applied a uniform ≥ 15 mmHg threshold; OCT studies used four distinct retinal nerve fiber layer algorithms approximating this threshold. Pooled prevalence was 38% (95% CI, 26-51%; I2 = 77.0%) by invasive monitoring (13 studies; n = 448) and 43% (95% CI, 28-61%; I2 = 83.8%) by OCT (4 studies; n = 272). The combined estimate was 39% (95% CI, 30-50%). By suture type, prevalence ranged from 33% (metopic) to 43% (sagittal) without significant differences (p = 0.89). Intraoperative studies yielded higher prevalence than preoperative (52% vs. 34%; p = 0.13). Meta-regression explained only 11.7% of between-study variance.
Conclusions:
Elevated ICP is reported in a substantial proportion of children with isolated SSC, although prevalence estimates vary considerably based on diagnostic methodology and timing of assessment. Across included studies, pooled estimates ranged between 30-50%. Noninvasive screening, such as OCT, may aid adequate detection in at-risk patients. Standardized ICP thresholds and longitudinal neurocognitive studies are needed to guide management and optimize outcomes.
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