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Chang YH, Staffa SJ, Yavuz Saricay L, Zurakowski D, Gise R, Dagi LR. Sensitivity, Specificity, and Cutoff Identifying Optic Atrophy by Macular Ganglion Cell Layer Volume in Syndromic Craniosynostosis. Ophthalmology 2024; 131:341-348. [PMID: 37742723 DOI: 10.1016/j.ophtha.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE To determine the sensitivity, specificity, and cutoff of macular ganglion cell layer (GCL) volume consistent with optic atrophy in children with syndromic craniosynostosis and to investigate factors independently associated with reduction in GCL volume. DESIGN Retrospective cross-sectional study. PARTICIPANTS Patients with syndromic craniosynostosis evaluated at Boston Children's Hospital (2010-2022) with reliable macular OCT scans. METHODS The latest ophthalmic examination that included OCT macula scans was identified. Age at examination, sex, ethnicity, best-corrected logarithm of the minimum angle of resolution (logMAR) visual acuity, cycloplegic refraction, and funduscopic optic nerve appearance were recorded in addition to history of primary or recurrent elevation in intracranial pressure (ICP), Chiari malformation, and obstructive sleep apnea (OSA). Spectral-domain OCT software quantified segmentation of macula retinal layers and was checked manually. MAIN OUTCOME MEASURES The primary outcome was determining sensitivity, specificity, and optimal cutoff of GCL volume consistent with optic atrophy. The secondary outcome was determining whether previously elevated ICP, OSA, Chiari malformation, craniosynostosis diagnosis, logMAR visual acuity, age, or sex were independently associated with lower GCL volume. RESULTS Median age at examination was 11.9 years (interquartile range, 8.5-14.8 years). Fifty-eight of 61 patients (112 eyes) had reliable macula scans, 74% were female, and syndromes represented were Apert (n = 14), Crouzon (n = 17), Muenke (n = 6), Pfeiffer (n = 6), and Saethre-Chotzen (n = 15). Optimal cutoff identifying optic atrophy was a GCL volume < 1.02 mm3 with a sensitivity of 83% and specificity of 77%. Univariate analysis demonstrated that significantly lower macular GCL volume was associated with optic atrophy on fundus examination (P < 0.001), Apert syndrome (P < 0.001), history of elevated ICP (P = 0.015), Chiari malformation (P = 0.001), OSA (P < 0.001), male sex (P = 0.027), and worse logMAR visual acuity (P < 0.001). Multivariable median regression analysis confirmed that only OSA (P = 0.005), optic atrophy on fundus examination (P = 0.003), and worse logMAR visual acuity (P = 0.042) were independently associated with lower GCL volume. CONCLUSIONS Surveillance for optic atrophy by GCL volume may be useful in a population where cognitive skills can limit acquisition of other key ophthalmic measures. It is noteworthy that OSA is also associated with lower GLC volume in this population. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Yoon-Hee Chang
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leyla Yavuz Saricay
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan Gise
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Chiu HH, Al-Farsi N, Wong AMF, Davis A, Tessaro MO, Wan MJ. Diagnostic utility of point-of-care ultrasound and optical coherence tomography for papilloedema in children: a prospective pilot study. Br J Ophthalmol 2024:bjo-2023-324552. [PMID: 38413191 DOI: 10.1136/bjo-2023-324552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND/AIMS Papilloedema is an important sign of serious neurological disease, but it can be difficult to detect on funduscopy. The purpose of this study was to determine the diagnostic accuracy of point-of-care ultrasound (POCUS) and optical coherence tomography (OCT) for detecting papilloedema in children. METHODS This was a prospective observational study at a tertiary care paediatric hospital. Patients were eligible for the study if they underwent a lumbar puncture with opening pressure and had high-quality POCUS and OCT imaging. RESULTS A total of 63 eyes from 32 patients were included in the study, 41 (65%) with papilloedema and 22 (35%) without. There were statistically significant differences between the groups in the optic disc elevation (ODE) (p<0.001) and optic nerve sheath diameter (ONSD) (p<0.001) on POCUS, and in the average retinal nerve fibre layer (rNFL) thickness on OCT (p<0.001). Average rNFL thickness had the highest diagnostic accuracy with an area under the curve (AUC) of 0.999 and a 100% sensitivity and 95% specificity for papilloedema (threshold value of ≥108 µm). ODE had an AUC of 0.866 and a 93% sensitivity and 55% specificity (threshold value of ≥0.5 mm). ONSD had an AUC of 0.786 and a 93% sensitivity and 45% specificity (threshold value of ≥5.5 mm). CONCLUSION Both OCT and POCUS are potentially useful tools to help diagnose papilloedema in children. Larger studies are needed to further define the role and accuracy of POCUS and OCT in assessing papilloedema in children.
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Affiliation(s)
- Hannah H Chiu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Nouf Al-Farsi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Agnes M F Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adrienne Davis
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Mark O Tessaro
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Wan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Doerga PN, Goederen RD, van Veelen MLC, Joosten KFM, Tasker RC, Mathijssen IMJ. What We Know About Intracranial Hypertension in Children With Syndromic Craniosynostosis. J Craniofac Surg 2023; 34:1903-1914. [PMID: 37487059 DOI: 10.1097/scs.0000000000009517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE A scoping review of literature about mechanisms leading to intracranial hypertension (ICH) in syndromic craniosynostosis (sCS) patients, followed by a narrative synopsis of whether cognitive and behavioral outcome in sCS is more related to genetic origins, rather than the result of ICH. METHODS The scoping review comprised of a search of keywords in EMBASE, MEDLINE, Web of science, Cochrane Central Register of Trials, and Google scholar databases. Abstracts were read and clinical articles were selected for full-text review and data were extracted using a structured template. A priori, the authors planned to analyze mechanistic questions about ICH in sCS by focusing on 2 key aspects, including (1) the criteria for determining ICH and (2) the role of component factors in the Monro-Kellie hypothesis/doctrine leading to ICH, that is, cerebral blood volume, cerebrospinal fluid (CSF), and the intracranial volume. RESULTS Of 1893 search results, 90 full-text articles met criteria for further analysis. (1) Invasive intracranial pressure measurements are the gold standard for determining ICH. Of noninvasive alternatives to determine ICH, ophthalmologic ones like fundoscopy and retinal thickness scans are the most researched. (2) The narrative review shows how the findings relate to ICH using the Monro-Kellie doctrine. CONCLUSIONS Development of ICH is influenced by different aspects of sCS: deflection of skull growth, obstructive sleep apnea, venous hypertension, obstruction of CSF flow, and possibly reduced CSF absorption. Problems in cognition and behavior are more likely because of genetic origin. Cortical thinning and problems in visual function are likely the result of ICH.
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Affiliation(s)
- Priya N Doerga
- Sophia Children's Hospital, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center
| | - Robbin de Goederen
- Sophia Children's Hospital, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center
| | - Marie-Lise C van Veelen
- Sophia Children's Hospital, Department of Neurosurgery, Erasmus MC, University Medical Center
| | - Koen F M Joosten
- Sophia Children's Hospital Pediatric Intensive Care Unit, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Robert C Tasker
- Department of Anaesthesia (Pediatrics) and Division of Critical Care Medicine, Harvard Medical School and Boston Children's Hospital, Boston, MA
| | - Irene M J Mathijssen
- Sophia Children's Hospital, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center
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Optic Nerve Ultrasound Evaluation in Children: A Review. Diagnostics (Basel) 2023; 13:diagnostics13030535. [PMID: 36766639 PMCID: PMC9914511 DOI: 10.3390/diagnostics13030535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Managing patients with neurocritical illness requires monitoring and treating elevated intracranial pressure (ICP), especially in cases in children. In terms of precise and real-time measurements, invasive ICP measurements are presently the gold standard for the initial diagnosis and follow-up ICP assessments. As a rapid and non-invasive way to detect elevated ICP, point-of-care ultrasonography (POCUS) of optic nerve sheath diameter (ONSD) has been proposed. The utility of bedside POCUS of ONSD to detect elevated ICP with excellent diagnostic test accuracy in adults has already been demonstrated. Nonetheless, data on the relationship between POCUS of ONSD and ICP in children are scarce. Therefore, the purpose of this review is to point out the most recent findings from the pediatric published literature and briefly discuss what was assessed with ONSD ultrasound examination, and also to describe and discuss the diagnostic procedures available for optic nerve ultrasound appraisal. A search of the medical databases PubMed and Scopus was carried out. The terms such as "ocular ultrasonography", "ICP assessment", "children", "point-of-care ultrasound", and "POCUS" were searched. In conclusion, the use of the standardized A-scan technique coupled with the B-scan technique should be suggested to provide data that are as accurate, precise, repeatable, and objective as possible.
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Momtaz OM, Said OM, Mohamed AM, Abdel Mawla TS. Value of Optic Nerve Sheath Diameter in Diagnosis and Follow Up of Patients with Disturbed Conscious Level. Eye Brain 2022; 14:115-126. [PMID: 36193222 PMCID: PMC9526430 DOI: 10.2147/eb.s369813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Ultrasonographic measurement of optic nerve sheath diameter is a simple, non-invasive, and reliable method of detecting elevated intracranial pressure (ICP) in critical patients. Optic nerve sheath communicates with the dura mater covering the brain and contains cerebrospinal fluid, allowing pressure transmission from the cranium. Therefore, changes in cerebrospinal fluid (CSF) pressure have been shown to produce changes in ONSD. Objective This study aimed to assess the accuracy of optic nerve sheath diameter (ONSD) in diagnosis and follow-up patients with disturbed conscious levels compared with CT brain and fundus examination. Patients and Methods One hundred forty-one participants were included in the study, classified into 76 cases admitted with disturbed conscious levels due to elevated ICP and 65 controls. All patients were subjected to CT brain and optic nerve US and fundus examination at the time of admission and follow-up after 48 h after proper management. Results The current study showed that ONSD is significant in predicting elevated ICP at the cut-off point of average ONSD of 5.19 mm with 97% sensitivity and 98% specificity, and the area under the curve (AUC) was 0.996. The present study revealed a significant inverse correlation between ONSD and GCS in patients with increased ICP. Conclusion Ultrasonic measurement of ONSD is a promising technique in diagnosing and following patients with disturbed conscious levels.
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Affiliation(s)
| | - Omar M Said
- Ophthalmology Department, Fayoum University, Fayoum, Egypt
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Rufai SR, Jeelani NUO, Bowman R, Bunce C, Proudlock FA, Gottlob I. Recognition of intracranial hypertension using handheld optical coherence tomography in children (RIO Study): a diagnostic accuracy study protocol. BMJ Open 2022; 12:e048745. [PMID: 35017232 PMCID: PMC8753392 DOI: 10.1136/bmjopen-2021-048745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Paediatric intracranial hypertension (IH) is a rare but serious condition that can pose deleterious effects on the brain and vision. Estimating intracranial pressure (ICP) in children is difficult. Gold standard direct ICP measurement is invasive and carries risk. It is impractical to routinely perform direct ICP measurements over time for all children at risk of IH. This study proposes to assess the diagnostic accuracy of handheld optical coherence tomography (OCT), a non-invasive ocular imaging method, to detect IH in children. METHODS AND ANALYSIS This is a prospective study evaluating the diagnostic accuracy of handheld OCT for IH in at risk children. Inclusion criteria include clinical and/or genetic diagnosis of craniosynostosis, idiopathic intracranial hypertension, space occupying lesion or other conditions association with IH and age 0-18 years old. Exclusion criteria include patients older than 18 years of age and/or absence of condition placing the child at risk of IH. The primary outcome measures are handheld OCT and 48-hour ICP assessments, which will be used for diagnostic accuracy testing (sensitivity, specificity, positive predictive value, negative predictive value and accuracy). Main secondary outcome measures include visual acuity, fundoscopic examination, contrast sensitivity, visual field testing and visual evoked potentials, wherever possible. ETHICS AND DISSEMINATION Ethical approval was granted for this study by the East Midlands Nottingham 2 Research Ethics committee (UOL0348/IRAS 105137). Our findings will be disseminated through presentation at relevant meetings, peer-reviewed publication and via the popular media. TRIAL REGISTRATION NUMBER ISRCTN52858719.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catey Bunce
- Clinical Trials Unit, Royal Marsden Hospital NHS Trust, London, UK
| | | | - Irene Gottlob
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
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Thompson DA, Marmoy OR, Prise KL, Reynolds VM, Handley SE, Versace DM, Kafiabadi S, Mankad K, Panteli V, Schwiebert K, James G, Bowman R. Giant pattern VEPs in children. Eur J Paediatr Neurol 2021; 34:33-42. [PMID: 34388649 DOI: 10.1016/j.ejpn.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/22/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
Our aim is to elaborate the clinical significance of giant amplitude pattern reversal visual evoked potentials (VEPs) in children. 'Giant' amplitude VEPs exceed the upper 97.5th centile, 90% CI for age. We scrutinised 2750 pattern VEPs recorded to international standards between Jan 2015 and 2017 from children aged 16 years and under, attending a specialist children's hospital. Twenty seven children, median age 6yrs, (range 1-16 yrs), were identified with giant VEPs (P100 amplitude range 65-163 μV). Most, 22/27 (81%), had conditions associated with a risk of raised ICP. Sixteen of these twenty two children had craniosynostosis; six multi-sutural and eight single suture disease. Others had Idiopathic Intracranial Hypertension, arachnoid cyst, NF1 with shunted hydrocephalus, chronic infantile neurological cutaneous and articular (CINCA) syndrome, nephrotic cystinosis and obstructive sleep apnoea. Five children presented with a range of conditions, some associated with seizures some symptomatic, but as yet undiagnosed. Frequent structural associations were optical coherence tomography measures of optic disc maximum anterior axial horizontal retinal thickness projection >160 μm and neuro-radiological findings of CSF effacement and copper beaten appearance. Ultrasonography measures of optic nerve sheath diameters varied, but in one child took 2 years to resolve after treatment for raised ICP. Optic disc gradings by fundoscopy were mostly normal, as were visual acuities. Raised ICP was confirmed by gold standard ICP bolt measurements in five of seven children tested. These data suggest that rICP should be considered if a child has sustained giant amplitude VEPs at normal latency.
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Affiliation(s)
- Dorothy A Thompson
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Ulverscroft Vision Research Group, UCL Great Ormond Street Institute for Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Oliver R Marmoy
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Ulverscroft Vision Research Group, UCL Great Ormond Street Institute for Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Katrina L Prise
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Victoria M Reynolds
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Sian E Handley
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Ulverscroft Vision Research Group, UCL Great Ormond Street Institute for Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Dominique M Versace
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Sina Kafiabadi
- Neuroradiology Department, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Kshitij Mankad
- Neuroradiology Department, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Vasiliki Panteli
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Kemmy Schwiebert
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Greg James
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Craniofacial Research Group, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Ulverscroft Vision Research Group, UCL Great Ormond Street Institute for Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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Rufai SR, Hisaund M, Jeelani NUO, McLean RJ. Detection of intracranial hypertension in children using optical coherence tomography: a systematic review. BMJ Open 2021; 11:e046935. [PMID: 34380720 PMCID: PMC8359522 DOI: 10.1136/bmjopen-2020-046935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the diagnostic capability of optical coherence tomography (OCT) in children aged under 18 years old with intracranial hypertension (IH). DESIGN Systematic review. METHODS We conducted a systematic review using the following platforms to search the keywords 'optical coherence tomography' and 'intracranial hypertension' from inception to 2 April 2020: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PubMed and Web of Science, without language restrictions. Our search returned 2729 records, screened by two independent screeners. Studies were graded according to the Oxford Centre for Evidence-Based Medicine and National Institutes of Health Quality Assessment Tool for observational studies. RESULTS Twenty-one studies were included. Conditions included craniosynostosis (n=354 patients), idiopathic IH (IIH; n=102), space-occupying lesion (SOL; n=42) and other pathology (n=29). OCT measures included optic nerve parameters, rim parameters (notably retinal nerve fibre layer thickness) and retinal parameters. Levels of evidence included 2b (n=13 studies), 3b (n=4) and 4 (n=4). Quality of 10 studies was fair and 11 poor. There was inconsistency in OCT parameters and reference measures studied, although OCT did demonstrate good diagnostic capability for IH in craniosynostosis, IIH and SOL. CONCLUSIONS This systematic review identified various studies involving OCT to assist diagnosis and management of IH in children with craniosynostosis, IIH, SOL and other pathology, in conjunction with established clinical measures of intracranial pressure. However, no level 1 evidence was identified. Validating prospective studies are, therefore, required to determine optimal OCT parameters in this role and to develop formal clinical guidelines. PROSPERO REGISTRATION NUMBER CRD42019154254.
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Affiliation(s)
- Sohaib R Rufai
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Michael Hisaund
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Rebecca J McLean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
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Rufai SR, Bowman R, Bunce C, Panteli V, McLean RJ, Teli S, Gottlob I, Thomas MG, Jeelani NUO, Proudlock FA. Feasibility and Repeatability of Handheld Optical Coherence Tomography in Children With Craniosynostosis. Transl Vis Sci Technol 2021; 10:24. [PMID: 34313724 PMCID: PMC8322722 DOI: 10.1167/tvst.10.8.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose To determine whether handheld optical coherence tomography (OCT) is feasible and repeatable in children with craniosynostosis. Methods This was a prospective cross-sectional study. Children with syndromic and non-syndromic craniosynostosis 0 to 18 years of age were recruited between February 13, 2020, and October 1, 2020. Main outcome measures included feasibility (patient recruitment and handheld OCT success rates) and repeatability, which were assessed using intraclass correlation coefficients (ICCs) where repeated images of the optic nerve head (ONH) within the same visit were available. ONH parameters used for repeatability analysis included cup depth, width, and area; disc width; rim height; retinal thickness; retinal nerve fiber layer thickness; and Bruch's membrane opening minimum rim width. Results Fifty children were approached, and all 50 (100%) were successfully recruited. Median age was 51.1 months (range, 1.9-156.9; interquartile range, 37.0-74.2), and 33 of the children (66%) were male. At least one ONH image was obtained in 43 children (86%), and bilateral ONH imaging was successful in 38 children (76%). Factors boosting the likelihood of success included good understanding and cooperation of the child and parent/guardian and availability of an assistant. Repeatability analysis was performed in 20 children, demonstrating good repeatability (ICC range, 0.77-0.99; the majority exceeded 0.90). OCT correctly identified two cases of intracranial hypertension, one of which was undetected by prior fundoscopy. Conclusions Handheld OCT is feasible and repeatable in children with syndromic and non-syndromic forms of craniosynostosis. Translational Relevance Our handheld OCT approach could be used for the clinical surveillance of children with craniosynostosis.
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Affiliation(s)
- Sohaib R. Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catey Bunce
- Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Vasiliki Panteli
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rebecca J. McLean
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Seema Teli
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Irene Gottlob
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Mervyn G. Thomas
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Noor ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Frank A. Proudlock
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
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Rufai SR, Jeelani NUO, McLean RJ. Early Recognition of Raised Intracranial Pressure in Craniosynostosis Using Optical Coherence Tomography. J Craniofac Surg 2021; 32:201-205. [PMID: 33185414 PMCID: PMC7769183 DOI: 10.1097/scs.0000000000006771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Craniosynostosis can be associated with raised intracranial pressure (ICP), which can pose deleterious effects on the brain and vision if untreated. Estimating ICP in children is challenging, whilst gold standard direct intracranial measurement of ICP is invasive and carries risk. This systematic review aims to evaluate the role of optical coherence tomography (OCT), a noninvasive imaging technique, for detecting raised ICP in children with craniosynostosis. METHODS The authors conducted a systematic review of the literature published from inception until 19 August, 2019 in the Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, and EMBASE. Eligible studies evaluated the role of OCT in detecting raised ICP in children aged 0 to 16 years with craniosynostosis. Main outcome measures were sensitivity and specificity of OCT parameters for raised ICP. Quality assessment was performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. RESULTS Out of 318 records identified, data meeting the inclusion criteria were obtained from 3 studies. The quality of 2 studies was poor whilst 1 was fair. Optical coherence tomography demonstrated higher sensitivity and specificity for detecting raised ICP compared to fundus examination, clinical history, radiological testing, and visual field testing. CONCLUSIONS This systematic review demonstrated a lack of quality evidence for OCT as a screening tool for children with craniosynostosis. Further research is required to clarify the strength of OCT in this role and to determine which OCT parameters are most appropriate.
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Affiliation(s)
- Sohaib R. Rufai
- University of Leicester Ulverscroft Eye Unit, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester
- Clinical and Academic Department of Ophthalmology
| | - Noor ul Owase Jeelani
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London
- Developmental Biology & Cancer Department, UCL GOS Institute of Child Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Rebecca J. McLean
- University of Leicester Ulverscroft Eye Unit, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester
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Rufai SR, Jeelani NUO, McLean RJ. Detection of intracranial hypertension in children using optical coherence tomography: a systematic review protocol. BMJ Open 2020; 10:e037833. [PMID: 32636287 PMCID: PMC7342863 DOI: 10.1136/bmjopen-2020-037833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Intracranial hypertension (ICH) in children can have deleterious effects on the brain and vision. It is notoriously difficult to estimate intracranial pressure (ICP) in children and existing methods deliver suboptimal diagnostic accuracy to be used as screening tools. Optical coherence tomography (OCT) may represent a valuable, non-invasive surrogate measure of ICP, as has been demonstrated in a number of associated conditions affecting adults. More recently, OCT has been employed within the paediatric age group. However, the role of OCT in detecting ICH in children has not been rigorously assessed in a systematic review for all relevant conditions. Here, we propose a systematic review protocol to examine the role of OCT in the detection of ICH in children. METHODS AND ANALYSIS Electronic searches in the Cochrane Central Register of Controlled Trials, Medline, Embase, Web of Science and PubMed will identify studies featuring OCT in detecting ICH in children. Two independent screeners will identify studies for inclusion using a screening questionnaire. The systematic search and screening will take place between 2 April 2020 and 1 June 2020, while we aim to complete data analysis by 1 September 2020. Quality assessment will be performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome measure is the sensitivity and specificity of OCT in detecting ICH in children. Secondary outcomes measures include conditions associated with ICH per study, direct ICP monitoring, sensitivity and specificity of other measures for ICP and OCT parameters used. ETHICS AND DISSEMINATION Ethical approval is not required for the proposed systematic review as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication. PROSPERO REGISTRATION NUMBER CRD42019154254.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Noor Ul Owase Jeelani
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Developmental Biology & Cancer Dept, UCL GOS Institute of Child Health, London, United Kingdom
| | - Rebecca J McLean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
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Lin JJ, Chen AE, Lin EE, Hsia SH, Chiang MC, Lin KL. Point-of-care ultrasound of optic nerve sheath diameter to detect intracranial pressure in neurocritically ill children - A narrative review. Biomed J 2020; 43:231-239. [PMID: 32335329 PMCID: PMC7424084 DOI: 10.1016/j.bj.2020.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/25/2022] Open
Abstract
The rapid diagnosis of increased intracranial pressure is urgently needed for therapeutic reasons in neurocritically ill children, however this can rarely be achieved without invasive procedures. Point-of-care ultrasound of the optic nerve sheath diameter has been proposed as a non-invasive and reliable means to detect increased intracranial pressure in adults. Accordingly, clinicians may be able to use this technique to initiate early treatment and monitor the effectiveness of treatment in conjunction with other clinical examination and diagnostic modalities. Two meta-analyses and a systematic review have been published on this topic in adults. However, data on the correlation between optic nerve sheath diameter and intracranial pressure in neurocritically ill children are scarce. The aim of this review was to briefly describe what is being measured with point-of-care ultrasound of the optic nerve sheath diameter, summarize the most recent findings from adult literature, and provide an update of current work in children.
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Affiliation(s)
- Jainn-Jim Lin
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Neurology, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Aaron E Chen
- Division of Pediatric Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Elaina E Lin
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Neonatology, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Intracranial pressure patterns in children with craniosynostosis utilizing optical coherence tomography. Childs Nerv Syst 2020; 36:535-544. [PMID: 31848721 DOI: 10.1007/s00381-019-04448-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 11/19/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Better understanding the incidence and patterns of elevated intracranial pressure (ICP) in patients with craniosynostosis may facilitate more timely intervention to alter neurocognitive outcomes. Spectral-domain optical coherence tomography (OCT) of the retina can non-invasively diagnose elevated ICP, and has demonstrated high sensitivity and specificity among patients with craniosynostosis. This study sought to characterize patterns of elevated ICP among patients with craniosynostosis. METHODS Quantitative retinal parameters were prospectively assessed in both eyes of patients with craniosynostosis using spectral-domain OCT. Based on retinal OCT thresholds associated with elevated ICP (> 15 mmHg), subjects were assigned an OCT diagnosis of elevated or non-elevated ICP which was analyzed relative to clinical characteristics and craniosynostosis patterns. RESULTS Eighty subjects (aged 0.2-18 years) with craniosynostosis were enrolled; among these, 67 (84%) were nonsyndromic. OCT evaluation was performed at initial vault expansion in 56 (70%) patients. Among this subset, 27 (48%) patients had peri-papillary changes suggestive of elevated ICP, reflecting a 44% incidence in nonsyndromic and 83% in syndromic patients. The median age at initial vault expansion was higher among those with elevated ICP (11.1 months) than those without (7.8 months; p = 0.04.) Multi-suture synostosis was associated with changes consistent with elevated ICP in 9 (75%) patients compared with 18 (41%) with single suture synostosis (p = 0.05). CONCLUSIONS OCT of the retina produces a potentially sensitive indicator of ICP in craniosynostosis patients. Elevated ICP may be associated with number of involved sutures and older patient presentation, and refining appropriate "cutoffs" will be important as the technology becomes more widespread.
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14
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Optic nerve sheath diameter measurement for predicting raised intracranial pressure in pediatric patients: A systematic review and meta-analysis. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919892775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background and objectives:No previous studies have investigated the relationship between the optic nerve sheath diameter and raised intracranial pressure in pediatric patients or have evaluated the usefulness of optic nerve sheath diameter in ocular ultrasound and brain computed tomography/magnetic resonance imaging. This study aimed to meta-analyze the diagnostic performance of optic nerve sheath diameter for the diagnosis of raised intracranial pressure in pediatric patients.Methods:A database search of PubMed and EMBASE was performed to identify relevant studies. Bivariate modeling and hierarchical summary receiver operating characteristics modeling were performed to evaluate diagnostic performance. A pooled diagnostic odds ratio with a 95% confidence interval, not including 1, was considered informative. Subgroup analysis was performed according to the modality (ocular ultrasound vs brain computed tomography/magnetic resonance imaging). We performed meta-regression analyses for heterogeneity exploration.Results:Eleven studies involving 546 patients were included. According to pooled diagnostic odds ratios, optic nerve sheath diameter was informative for the evaluation of raised intracranial pressure (diagnostic odds ratio, 47; 95% confidence interval, 11–206). Optic nerve sheath diameter showed a pooled sensitivity of 0.88 (95% confidence interval, 0.79–0.94), a pooled specificity of 0.86 (95% confidence interval, 0.70–0.95), and an area under the hierarchical summary receiver operating characteristics curve of 0.93 (95% confidence interval, 0.91–0.95) for the diagnosis of raised intracranial pressure. According to the subgroup analysis, ocular ultrasound (sensitivity, 0.91 (95% confidence interval, 0.81–0.96); specificity, 0.86 (95% confidence interval, 0.65–0.96)) showed higher sensitivity and comparable specificity than optic nerve sheath diameter measured on brain computed tomography/magnetic resonance imaging (sensitivity, 0.75 (95% confidence interval, 0.51–0.99); specificity, 0.91 (95% confidence interval, 0.74–1.00)). On meta-regression analysis, the study design, number of patients, and reference standard were the sources of heterogeneity.Conclusion:Optic nerve sheath diameter may be a useful method for predicting raised intracranial pressure in pediatric patients. We recommend that the measurement of optic nerve sheath diameter should be performed using ocular ultrasound for a more accurate diagnosis of raised intracranial pressure in pediatric patients.
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Ganesh A, Edmond J, Forbes B, Katowitz WR, Nischal KK, Miller M, Levin AV. An update of ophthalmic management in craniosynostosis. J AAPOS 2019; 23:66-76. [PMID: 30928366 DOI: 10.1016/j.jaapos.2018.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/26/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022]
Abstract
Craniosynostosis has a varied clinical spectrum, ranging from isolated single suture involvement to multisutural fusions. Syndromic and nonsyndromic patients require orchestrated and multidisciplinary care from birth to adulthood. Advances in our understanding of craniosynostosis over the last quarter-century have resulted in more systematic management of the problems associated with the syndromic and nonsyndromic forms of this condition. This review provides an update on the genetic basis of, management of strabismus and oculoplastic manifestations in, and visual surveillance of patients with craniosynostosis.
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Affiliation(s)
- Anuradha Ganesh
- Department of Ophthalmology, Sultan Qaboos University Hospital, Sultanate of Oman
| | - Jane Edmond
- Departments of Ophthalmology and Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Brian Forbes
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - William R Katowitz
- Oculoplastic and Orbital Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ken K Nischal
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | | | - Alex V Levin
- Wills Eye Institute, Philadelphia, Pennsylvania.
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16
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Simonin A, Maduri R, Viaroli E, Levivier M, Daniel RT, Messerer M. Correlation between Papilledema and Intracranial Hypertension in Crouzon Syndrome: A Case Report and Review of the Literature. Pediatr Neurosurg 2019; 54:223-227. [PMID: 31269504 DOI: 10.1159/000500767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/05/2019] [Indexed: 11/19/2022]
Abstract
Crouzon syndrome represents the most common syndromic craniosynostosis. Ocular complications are frequent, including papilledema and optic atrophy, often related to increased intracranial pressure (ICP). However, there is a poor correlation between ICP normalization and resolution of papilledema. We describe the case of a 6-month-old infant who presented with typical phenotypic features of Crouzon syndrome. Pre- and postoperative ICP monitoring was used. Papilledema persisted despite ICP improvement after decompressive craniectomy. Possible causes of papilledema in this syndromic craniosynostosis are discussed in light of the existing literature.
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Affiliation(s)
- Alexandre Simonin
- Neurosurgery, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,
| | - Rodolfo Maduri
- Neurosurgery, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Edoardo Viaroli
- Neurosurgery, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Marc Levivier
- Neurosurgery, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Roy Thomas Daniel
- Neurosurgery, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Mahmoud Messerer
- Neurosurgery, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Haredy M, Zuccoli G, Tamber M, Davis A, Nischal K, Goldstein JA. Use of neuroimaging measurements of optic nerve sheath diameter to assess intracranial pressure in craniosynostosis. Childs Nerv Syst 2018; 34:939-946. [PMID: 29380112 DOI: 10.1007/s00381-018-3728-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/16/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE This study aims to evaluate accuracy of optic nerve sheath diameter (ONSD) measurements obtained by magnetic resonance imaging (MRI) in patients with craniosynostosis (CS) for detection of high intracranial pressure (ICP) and to correlate MRI-derived ONSD measurements with those obtained by computed tomography (CT) scans in CS patients. METHODS A retrospective review was conducted on CS patients who had MRI- and age-matched controls with normal MRI. Diagnosis of intracranial hypertension was based on presence of papilledema, direct ICP monitoring, and/or lumbar puncture. The search also included patients with MRI and CT done within 30 days apart. ONSDs were measured 3 mm behind the globe on both modalities. RESULTS The study identified 56 CS patients (mean age 3.8 ± 3.47 years) and 49 controls (mean age 3.7 ± 3.62 years). Mean ONSD in patients with high ICP was significantly higher than in patients without high ICP (P = 0.0001) and in controls (P < 0.0001). The optimal ONSD threshold for predicting raised ICP in patients >1 year old was 6 mm (71.4% sensitivity, 89.7% specificity). Nineteen patients with 38 single-eye MRI/CT pairs were identified. Substantial agreement between both modalities resulted (r = 0.959, 95% CI 0.923-0.978), and Bland and Altman Plot analysis showed that 95% of measurements fell within limits of agreement (1.96 SD; ± 0.6 mm). CONCLUSION In CS patients, ONSD measured by MRI represent indirect non-invasive means of ICP assessment. Both MRI and CT measurements of ONSD gave comparable results, and the use of CT-derived ONSD measurements may give some idea about ICP in CS patients.
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Affiliation(s)
- Mostafa Haredy
- Department of Plastic Surgery - Cleft-Craniofacial Center, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, 15224, USA.
- Plastic Surgery Department - Cleft and Craniofacial Unit, Sohag University Hospital, Sohag, 82524, Egypt.
| | - Giulio Zuccoli
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mandeep Tamber
- Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amani Davis
- Department of Ophthalmology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ken Nischal
- Department of Ophthalmology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- Department of Plastic Surgery - Cleft-Craniofacial Center, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, 15224, USA
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Swanson JW, Aleman TS, Xu W, Ying GS, Pan W, Liu GT, Lang SS, Heuer GG, Storm PB, Bartlett SP, Katowitz WR, Taylor JA. Evaluation of Optical Coherence Tomography to Detect Elevated Intracranial Pressure in Children. JAMA Ophthalmol 2017; 135:320-328. [PMID: 28241164 DOI: 10.1001/jamaophthalmol.2017.0025] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Detecting elevated intracranial pressure in children with subacute conditions, such as craniosynostosis or tumor, may enable timely intervention and prevent neurocognitive impairment, but conventional techniques are invasive and often equivocal. Elevated intracranial pressure leads to structural changes in the peripapillary retina. Spectral-domain (SD) optical coherence tomography (OCT) can noninvasively quantify retinal layers to a micron-level resolution. Objective To evaluate whether retinal measurements from OCT can serve as an effective surrogate for invasive intracranial pressure measurement. Design, Setting, and Participants This cross-sectional study included patients undergoing procedures at the Children's Hospital of Philadelphia from September 2014 to June 2015. Three groups of patients (n = 79) were prospectively enrolled from the Craniofacial Surgery clinic including patients with craniosynostosis (n = 40). The positive control cohort consisted of patients with hydrocephalus and suspected intracranial hypertension (n = 5), and the negative control cohort consisted of otherwise healthy patients undergoing a minor procedure (n = 34). Main Outcomes and Measures Spectral-domain OCT was performed preoperatively in all cohorts. Children with cranial pathology, but not negative control patients, underwent direct intraoperative intracranial pressure measurement. The primary outcome was the association between peripapillary retinal OCT parameters and directly measured elevated intracranial pressure. Results The mean (SD) age was 34.6 (45.2) months in the craniosynostosis cohort (33% female), 48.9 (83.8) months in the hydrocephalus and suspected intracranial hypertension cohort (60% female), and 59.7 (64.4) months in the healthy cohort (47% female). Intracranial pressure correlated with maximal retinal nerve fiber layer thickness (r = 0.60, P ≤ .001), maximal retinal thickness (r = 0.53, P ≤ .001), and maximal anterior retinal projection (r = 0.53, P = .003). Using cut points derived from the negative control patients, OCT parameters yielded 89% sensitivity (95% CI, 69%-97%) and 62% specificity (95% CI, 41%-79%) for detecting elevated intracranial pressure. The SD-OCT measures had high intereye agreement (intraclass correlation, 0.83-0.93) and high intragrader and intergrader agreement (intraclass correlation ≥0.94). Conventional clinical signs had low sensitivity (11%-42%) for detecting intracranial hypertension. Conclusions and Relevance Noninvasive quantitative measures of the peripapillary retinal structure by SD-OCT were correlated with invasively measured intracranial pressure. Optical coherence tomographic parameters showed promise as surrogate, noninvasive measures of intracranial pressure, outperforming other conventional clinical measures. Spectral-domain OCT of the peripapillary region has the potential to advance current treatment paradigms for elevated intracranial pressure in children.
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Affiliation(s)
- Jordan W Swanson
- Craniofacial Surgery Center and Division of Plastic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia
| | - Tomas S Aleman
- Scheie Eye Institute and the Department of Ophthalmology, Perelman Center for Advanced Medicine and the University of Pennsylvania, Philadelphia3Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wen Xu
- Craniofacial Surgery Center and Division of Plastic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia
| | - Gui-Shuang Ying
- Scheie Eye Institute and the Department of Ophthalmology, Perelman Center for Advanced Medicine and the University of Pennsylvania, Philadelphia
| | - Wei Pan
- Scheie Eye Institute and the Department of Ophthalmology, Perelman Center for Advanced Medicine and the University of Pennsylvania, Philadelphia
| | - Grant T Liu
- Scheie Eye Institute and the Department of Ophthalmology, Perelman Center for Advanced Medicine and the University of Pennsylvania, Philadelphia3Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Shih-Shan Lang
- Division of Neurosurgery, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia
| | - Gregory G Heuer
- Division of Neurosurgery, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia
| | - Phillip B Storm
- Division of Neurosurgery, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia
| | - Scott P Bartlett
- Craniofacial Surgery Center and Division of Plastic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia
| | - William R Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jesse A Taylor
- Craniofacial Surgery Center and Division of Plastic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia
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Szmygel Ł, Kosiak W, Zorena K, Myśliwiec M. Optic Nerve and Cerebral Edema in the Course of Diabetic Ketoacidosis. Curr Neuropharmacol 2017; 14:784-791. [PMID: 26915420 PMCID: PMC5333594 DOI: 10.2174/1570159x14666160225155151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/22/2022] Open
Abstract
In the recent years we have been observing an increased incidence of type 1 diabetes in children and adolescents. This leads to a more frequent acute complication of type 1 diabetes among children with hyperglycemia. The most common of these is diabetic ketoacidosis (DKA), while cerebral edema is the most dangerous. In children with DKA, cerebral edema most often presents with clinical symptoms but may also appear in the so-called "subclinical" form. That is why the search continues for new methods of assessing and monitoring cerebral edema in the course of DKA treatment. Ultrasonographic optic nerve sheath diameter (US ONSD) assessment is performed in various clinical scenarios when cerebral edema is suspected. It is most often performed in adult patients but increasingly often in children. US ONSD assessment is useful in the treatment of DKA in children with type 1 diabetes. This manuscript provides an overview of research results available in PubMed and other available databases on the course of treatment of DKA in children with type 1 diabetes.
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Affiliation(s)
- Łukasz Szmygel
- Clinic of Pediatrics Diabetology and Endocrinology, Medical University of Gdansk, 80-952 Gdansk, Poland
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Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, Gary B, Holmes JF, Kessler DO, Lam SHF, Levine MC, Levy JA, Murray A, Ng L, Noble VE, Ramirez-Schrempp D, Riley DC, Saul T, Shah V, Sivitz AB, Tay ET, Teng D, Chaudoin L, Tsung JW, Vieira RL, Vitberg YM, Lewiss RE. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016; 8:16. [PMID: 27812885 PMCID: PMC5095098 DOI: 10.1186/s13089-016-0049-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/01/2016] [Indexed: 12/19/2022] Open
Abstract
The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed "how to" and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.
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Affiliation(s)
- Jennifer R. Marin
- Children’s Hospital of Pittsburgh, 4401 Penn Ave, AOB Suite 2400, Pittsburgh, PA 15224 USA
| | - Alyssa M. Abo
- Children’s National Medical Center, Washington DC, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Lorraine Ng
- Morgan Stanley Children’s Hospital, New York, NY USA
| | | | | | | | | | | | | | | | - David Teng
- Cohen Children’s Medical Center, New Hyde Park, USA
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About Intracranial Hypertension in Pediatric Patients: Good News About Treatment...But What About the Role of Optic Nerve Sheath Diameter Measurement in the Diagnosis? Pediatr Crit Care Med 2016; 17:706-7. [PMID: 27387784 DOI: 10.1097/pcc.0000000000000812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wu A, Collins ME. Newer Understanding of Eye Issues in Craniofacial Malformations. CURRENT OPHTHALMOLOGY REPORTS 2015. [DOI: 10.1007/s40135-015-0084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Maissan IM, Dirven PJAC, Haitsma IK, Hoeks SE, Gommers D, Stolker RJ. Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. J Neurosurg 2015; 123:743-7. [PMID: 25955869 DOI: 10.3171/2014.10.jns141197] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECT Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is known to be an accurate monitor of elevated intracranial pressure (ICP). However, it is yet unknown whether fluctuations in ICP result in direct changes in ONSD. Therefore, the authors researched whether ONSD and ICP simultaneously change during tracheal manipulation in patients in the intensive care unit (ICU) who have suffered a traumatic brain injury (TBI). MATERIALS The authors included 18 ICP-monitored patients who had sustained TBI and were admitted to the ICU. They examined the optic nerve sheath by performing ultrasound before, during, and after tracheal manipulation, which is known to increase ICP. The correlation between ONSD and ICP measurements was determined, and the diagnostic performance of ONSD measurement was tested using receiver operating characteristic curve analysis. RESULTS In all patients ICP increased above 20 mm Hg during manipulation of the trachea, and this increase was directly associated with a dilation of the ONSD of > 5.0 mm. After tracheal manipulation stopped, ICP as well as ONSD decreased immediately to baseline levels. The correlation between ICP and ONSD was high (R(2) = 0.80); at a cutoff of ≥ 5.0 mm ONSD, a sensitivity of 94%, a specificity of 98%, and an area under the curve of 0.99 (95% CI 0.97-1.00) for detecting elevated ICP were determined. CONCLUSIONS In patients who have sustained a TBI, ultrasonography of the ONSD is an accurate, simple, and rapid measurement for detecting elevated ICP as well as immediate changes in ICP. Therefore, it might be a useful tool to monitor ICP, especially in conditions in which invasive ICP monitoring is not available, such as at trauma scenes.
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Affiliation(s)
| | | | | | | | - Diederik Gommers
- Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
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Optical coherence tomography: a quantitative tool to screen for papilledema in craniosynostosis. Childs Nerv Syst 2014; 30:1067-73. [PMID: 24519451 DOI: 10.1007/s00381-014-2376-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/28/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE Our aim was to evaluate if optical coherence tomography (OCT) can be used as an alternative for fundoscopy to screen for increased intracranial pressure (ICP) in children with craniosynostosis METHODS We performed a prospective cohort study at the Dutch Craniofacial Centre. We included 38 patients with nonsyndromic scaphocephaly and Crouzon's syndrome aged 3-8 years old, in whom we scored complaints suggestive of increased ICP and performed fundoscopy and OCT. Main outcome measures total retinal thickness (TRT) which was measured on 58 OCT scans. RESULTS Forty-three percent of fundoscopies revealed pathologic changes of the papil in at least one eye. Retinal thickness was increased in patients with an abnormal fundoscopy as compared to patients with a normal papil (TRT p < 0.001). Patients with Crouzon's syndrome had a significantly increased retinal thickness as compared to patients with scaphocephaly (TRT p < 0.001). CONCLUSIONS The current study demonstrates that OCT in children with craniosynostosis is feasible. It confirms that retinal thickness increases in case of papilledema. Given the quantitative character, OCT has a high potential as an alternative tool to screen for papilledema in craniosynostosis and other pediatric populations.
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Abstract
Although most cases of craniosynostosis are nonsyndromic, craniosynostosis is known to occur in conjunction with other anomalies in well-defined patterns that make up clinically recognized syndromes. Patients with syndromic craniosynostoses are much more complicated to care for, requiring a multidisciplinary approach to address all of their needs effectively. This review describes the most common craniosynostosis syndromes, their characteristic features and syndrome-specific functional issues, and new modalities utilized in their management. General principles including skull development, the risk of developing increased intracranial pressure in craniosynostosis syndromes, and techniques to measure intracranial pressure are discussed. Evolving techniques of the established operative management of craniosynostosis are discussed together with more recent techniques including spring cranioplasty and posterior cranial vault distraction osteogenesis.
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Affiliation(s)
- Christopher Derderian
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Messerer M, Berhouma M, Messerer R, Dubourg J. [Interest of optic nerve sheath diameter ultrasonography in dectecting non-invasively raised intracranial pressure]. Neurochirurgie 2013; 59:55-9. [PMID: 23523218 DOI: 10.1016/j.neuchi.2013.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 01/06/2013] [Accepted: 02/02/2013] [Indexed: 10/27/2022]
Abstract
Intracranial hypertension is an emergency suspected from clinical symptoms, imaging data and ophthalomologic signs. Intracranial hypertension is confirmed by invasive intracranial monitoring, which is the gold standard technique to measure intracranial pressure (ICP). Because of complications, hemorrhage or infection, non-invasive methods have been developed such as neuroimaging, transcranial Doppler sonography and optic nerve sheath diameter (ONSD) ultrasonography. We have reviewed ONSD technique that detects intracranial hypertension related volume variations of subarachnoid space along the retro bulbar segment of the optic nerve. Technique, indications and prospects are discussed.
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Affiliation(s)
- M Messerer
- Service de neurochirurgie, département des neurosciences cliniques, centre hospitalier universitaire Vaudois, Lausanne, Suisse
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Tamburrini G, Caldarelli M, Massimi L, Gasparini G, Pelo S, Di Rocco C. Complex craniosynostoses: a review of the prominent clinical features and the related management strategies. Childs Nerv Syst 2012; 28:1511-23. [PMID: 22872268 DOI: 10.1007/s00381-012-1819-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/22/2012] [Indexed: 11/30/2022]
Abstract
The protocols for clinical evaluation and management of children with complex craniosynostoses are significantly different from those used in single suture forms. The time at which the various anatomical and functional anomalies observed in the affected subjects become clinically relevant varies from patient to patient, consequently requiring a tailored approach. The clinical course is variable and influenced by multiple factors, acting at different steps of the children growth. Intracranial hypertension is a major concern already in the first months of life; active cerebrospinal fluid (CSF) dynamics disorders, venous hypertension, and progressive craniocerebral disproportion are considered the main pathogenetic factors. Cranial vault and skull base sutures synostoses account for the frequently observed increased venous pressure. Skull base abnormalities lead to upper airways obstruction, which, on one side, might create significant upper airways obstructive problems and, on the other, contribute to the increase in the intracranial pressure. Secondary Chiari malformation is common and considered as a progressive disorder, mainly due to progressive craniocerebral disproportion, venous hypertension, and CSF dynamics disorders. Optic nerve and orbit-related eye-globe diseases are also a major concern. Papilledema is mostly related to increased intracranial pressure. The skull base synostotic process is the base of significant abnormalities of the orbital space, ending in the common feature of significant proptosis with the consequent risk of corneal ulcers. Aims of this paper are to analyze the physiopathogenetic mechanisms at the base of the clinical manifestations presented by children with complex craniosynostoses, and the therapeutic options currently available.
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Affiliation(s)
- G Tamburrini
- Pediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Largo "A. Gemelli", 8, 00168, Rome, Italy.
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Dubourg J, Javouhey E, Messerer M. Letter to the editor: optic nerve sheath diameter and intracranial pressure. J Neurosurg Pediatr 2012; 9:570-1; author reply 571. [PMID: 22546038 DOI: 10.3171/2011.10.peds11458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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