Chaij Jasmine, Liu Jiawei, French Brooke, Mirsky David, Miles Randy C, George Linguraru Marius, Nguyen Phuong D, Alexander Allyson L, Görg Carsten, Porras Antonio R
From the Department of Pediatric Plastic and Reconstructive Surgery, Children's Hospital Colorado, Aurora, CO.
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
Plast Reconstr Surg Glob Open. 2025 Mar 20;13(3):e6618. doi: 10.1097/GOX.0000000000006618. eCollection 2025 Mar.
Despite the clinical importance of identifying increased intracranial pressure (IIP) in children with craniosynostosis (CS), its presence is often uncertain due to limited utilization of invasive measurement methods, inconclusive clinical evaluations, and its variability depending on the CS phenotype. Hence, prevalence reports are highly variable. We previously developed a computational method to identify pediatric chronic IIP of diverse etiology based on subtle cranial thickness and density anomalies quantified from computed tomography (CT) scans. In this study, we evaluate cranial signs of IIP in a large dataset of presurgical CT scans of patients with diverse phenotypes of CS and its prevalence.
We quantified local cranial thickness and density in the CT scans of 417 patients with diverse phenotypes of CS (age 0-2 y). We used a normative reference of cranial development to quantify cranial bone anomalies in each phenotypic group and compared them with 48 patients with chronic IIP unrelated to CS. We then studied the risk of IIP and its prevalence in each phenotypic group of CS.
Patients with CS presented significant calvarial thickening and bone density decrease compared with normative patients ( < 0.001). Similar findings were found in patients with chronic IIP unrelated to CS ( > 0.23). Presurgical signs of IIP were more prevalent in patients with Apert syndrome (>74% patients) and nonsyndromic patients with coronal involvement (>30%) compared with other phenotypes (>18%).
Computational evaluation of routinely acquired presurgical CT scans can potentially support the evaluation of IIP in patients with CS.
尽管在颅缝早闭（CS）患儿中识别颅内压升高（IIP）具有临床重要性，但由于侵入性测量方法使用有限、临床评估结果不明确以及其因CS表型而异，IIP的存在往往难以确定。因此，患病率报告差异很大。我们之前开发了一种计算方法，可根据计算机断层扫描（CT）扫描量化的细微颅骨厚度和密度异常来识别不同病因的小儿慢性IIP。在本研究中，我们在一个包含多种CS表型患者的术前CT扫描大型数据集中评估IIP的颅骨体征及其患病率。
我们对417例不同CS表型（年龄0 - 2岁）患者的CT扫描中的局部颅骨厚度和密度进行了量化。我们使用颅骨发育的标准参考来量化每个表型组中的颅骨异常，并将其与48例与CS无关的慢性IIP患者进行比较。然后，我们研究了每个CS表型组中IIP的风险及其患病率。
与标准患者相比，CS患者出现明显的颅骨增厚和骨密度降低（<0.001）。在与CS无关的慢性IIP患者中也发现了类似的结果（>0.23）。与其他表型（>18%）相比，Apert综合征患者（>74%）和冠状缝受累的非综合征患者（>30%）中IIP的术前体征更为普遍。
对常规获取的术前CT扫描进行计算评估可能有助于评估CS患者的IIP。
