Tuite G F, Evanson J, Chong W K, Thompson D N, Harkness W F, Jones B M, Hayward R D
Craniofacial Unit, Great Ormond Street Hospital for Children, London, England.
Neurosurgery. 1996 Oct;39(4):691-9. doi: 10.1097/00006123-199610000-00007.
The beaten copper appearance of the cranium, as well as other cranial radiographic and computed tomographic findings in children with craniosynostosis, is often interpreted by clinicians as evidence of elevated intracranial pressure (ICP). However, a correlation between radiological findings and ICP measurements has not been previously demonstrated, and their usefulness in detecting elevated ICP has not been defined.
To address those issues, 123 children with craniosynostosis who had cranial radiographs and ICP monitoring were studied. To assess the specificity of certain radiological findings to patients with craniosynostosis, cranial radiographs of patients with craniosynostosis were compared to those of age- and sex-matched controls. In patients with craniosynostosis, findings on cranial radiographs were compared to computed tomographic scans of the brain. Radiographic findings were then correlated with ICP measurements obtained while the patient was sleeping, which was measured using a Camino fiberoptic ICP monitor (Camino Laboratories, San Diego, CA). All radiographs were independently analyzed by two radiologists who were blinded to clinical and ICP data.
A diffuse beaten copper pattern, erosion of the dorsum sellar, and suture diastasis were seen more commonly in patients with craniosynostosis than in controls (P < 0.05), but the presence of the beaten copper pattern was no more common in children with craniosynostosis. ICP was greater when a diffuse beaten copper pattern, dorsum sellar erosion, suture diastasis, or narrowing of basal cisterns was present (P < 0.05).
Although this study demonstrates that some cranial radiographic and computed tomographic findings do correlate with elevated ICP, the sensitivity of radiological methods for detecting elevated ICP is universally low and they are not recommended to screen for elevated ICP in children with craniosynostosis.
颅骨呈现出的 beaten copper 外观以及颅缝早闭患儿的其他颅骨放射学和计算机断层扫描结果，临床医生常常将其解读为颅内压（ICP）升高的证据。然而，此前尚未证实放射学检查结果与 ICP 测量值之间存在相关性，且未明确这些检查结果在检测 ICP 升高方面的作用。
为解决这些问题，对 123 例接受了颅骨 X 光片检查和 ICP 监测的颅缝早闭患儿进行了研究。为评估某些放射学检查结果对于颅缝早闭患者的特异性，将颅缝早闭患者的颅骨 X 光片与年龄和性别匹配的对照组患者的进行了比较。在颅缝早闭患者中，将颅骨 X 光片上的检查结果与脑部计算机断层扫描结果进行了比较。然后将放射学检查结果与患者睡眠时获得的 ICP 测量值进行相关性分析，ICP 使用 Camino 光纤 ICP 监测仪（加利福尼亚州圣地亚哥的 Camino 实验室）进行测量。所有 X 光片均由两名对临床和 ICP 数据不知情的放射科医生独立分析。
弥漫性 beaten copper 模式、鞍背侵蚀和缝间骨增宽在颅缝早闭患者中比对照组更常见（P < 0.05），但 beaten copper 模式在颅缝早闭患儿中并不更常见。当存在弥漫性 beaten copper 模式、鞍背侵蚀、缝间骨增宽或基底池变窄时，ICP 更高（P < 0.05）。
尽管本研究表明一些颅骨放射学和计算机断层扫描结果确实与 ICP 升高相关，但放射学方法检测 ICP 升高的敏感性普遍较低，不建议用于筛查颅缝早闭患儿的 ICP 升高情况。
