Quantitative Detection and Follow-Up of Intracranial Hypertension in Craniosynostosis: An Optical Coherence Tomography Study.

IF 3.2 2区医学 Q1 SURGERY Plastic and reconstructive surgery Pub Date : 2024-11-01 Epub Date: 2023-11-06 DOI:10.1097/PRS.0000000000011177

Bianca K den Ottelander, Stephanie D C van de Beeten, Sumin Yang, M L C van Veelen, Robert C Tasker, Sjoukje E Loudon, Irene M J Mathijssen

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Abstract

Background: In patients with craniosynostosis, the authors evaluated the diagnostic accuracy of fundoscopy and optical coherence tomography (OCT) to detect intracranial hypertension (ICH), the time course of retinal thickness after treatment of ICH, and the relationship between high hyperopia (HH) and fundoscopy/OCT scan findings.

Methods: Patients with syndromic, multisuture, unicoronal, unilambdoid, or sagittal synostosis visiting the authors' national center were included in this longitudinal cohort study and formed a consecutive series. Retinal layers on OCT, OCT fundus images, and fundoscopy results were evaluated. ICH was scored according to presence of abnormal intracranial pressures, hydrocephalus, progressive cerebellar tonsillar herniation or fingerprinting, and growth arrest. Diagnostic accuracy of OCT, fundoscopy, and fundus image; the time course of retinal thickness after ICH; and interference of HH were analyzed using linear mixed models.

Results: A total of 577 OCT scans in 307 patients were included. ICH was found in 7.2%. Combining total retinal thickness (TRT), OCT fundus imaging and fundoscopy resulted in a sensitivity of 76% and 81% specificity to detect signs of ICH. TRT was increased in patients who had had signs of ICH versus patients who had never had signs of ICH (β +44.9 µm in patients who had had ICH [95% CI, 9.0 to 80.8]; P = 0.01). TRT decreased to normal in the years after surgery (β -3.6 µm/yr [95% CI, -7.2 to -0.05]; P = 0.047). There were greater odds of having increased TRT in patients with HH (OR, 2.9 [95% CI, 1.1 to 7.6]; P = 0.03).

Conclusions: The correlation among TRT, OCT fundus image, fundoscopy, and particularly the combination of these measures with intracranial pressure surrogate markers is fair. Increased TRT in the presence of a clinical suspicion of ICH warrants further screening.

Clinical question/level of evidence: Diagnostic, III.

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开颅手术中颅内高压的定量检测和随访：一项光学相干断层扫描研究。

背景/目的：评估开颅手术：1）眼底镜和光学相干断层扫描（OCT）对颅内高压（ICH）的诊断准确性；2） ICH治疗后视网膜厚度的时间过程；3）高度远视（HH）与眼底镜/OCT扫描结果的关系。方法：将访问我们国家中心的综合征、多关节、单冠状动脉、单腔和矢状缝狭窄症患者纳入本纵向队列研究，并形成连续系列。对OCT、OCT眼底图像和眼底镜检查的视网膜层进行评估。ICH根据颅内压异常、脑积水、进行性小脑扁桃体突出或指纹和生长停滞进行评分。使用线性混合模型分析OCT、眼底镜和眼底图像的诊断准确性、ICH后视网膜厚度的时间进程和HH的干扰。结果：纳入307例患者的577次OCT扫描。脑出血发生率为7.2%。结合视网膜总厚度（TRT）、OCT眼底图像和眼底镜检查，检测脑出血迹象的敏感性为76%，特异性为81%。有脑出血症状的患者与从未有脑出血迹象的患者相比，TRT增加（有脑出血患者的β+44.9µm，95%CI 9.0-80.8，P=0.01）。术后几年TRT降至正常（β-3.6µm/年，95%CI-7.2--0.05，P=0.047）。HH患者TRT增加的几率更大（OR 2.9，95%CI1.1-7.6，P=0.03）在TRT、OCT眼底图像、眼底镜检查之间，尤其是对于这些参数与ICP替代标记物的组合而言，是公平的。临床怀疑脑出血时TRT升高，需要进一步筛查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

期刊介绍： For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.