Ophthalmologic Detection of Intracranial Hypertension in Surgical Patients with Craniosynostosis: A Diagnostic Accuracy Study

Abstract

Purpose : To assess the diagnostic accuracy of fundoscopy and visual evoked potentials (VEPs) in detecting intracranial hypertension (IH) in patients with syndromic and non-syndromic craniosynostosis undergoing spring-assisted posterior vault expansion (sPVE) surgery; to evaluate visual outcomes.

Methods : Children with craniosynostosis undergoing sPVE and 48-hour intracranial pressure (ICP) monitoring at a quaternary centre were included in this retrospective diagnostic accuracy study. Longitudinal data for ICP, fundoscopy, VEP and best-corrected visual acuity (BCVA) were collected between February 2002 and March 2019. Primary outcome measures were papilloedema on fundoscopy, VEP assessments and IH, defined as mean ICP >20 mmHg. Diagnostic indices were calculated for fundoscopy and VEP against ICH. Secondary outcome measures included final visual outcomes.

Results : Fundoscopic examinations within 6 months of ICP assessments were available for 35 children and isolated VEPs for 29 children, of which 22 children had at least three serial VEPs. Specificity for IH was 100% for all measures. Sensitivity was poor for fundoscopy (32.1%; 95% CI: 15.9-52.4), moderate for isolated VEP (65.2%; 95% CI 44.9-81.2) and good for serial VEP stability (82.4%; 95% CI: 56.6-96.2). Median final BCVA was 0.24 logMAR (n=36; IQR: 0.51; range: -0.06 to 2.7). UK driving standard BCVA was achieved by 26 patients (72.2%), defined as >0.30 logMAR in the better eye.

Conclusions : Papilloedema present on fundoscopy reliably indicated IH, but its absence did not exclude IH. VEP monitoring demonstrated higher sensitivity for detecting IH, with serial testing increasing sensitivity even further. To the best of our knowledge, this represents the largest study of its kind.

This is a 2021 ARVO Annual Meeting abstract.